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This Week in JAMA
January 24/31, 2001

This Week in JAMA

JAMA. 2001;285(4):371. doi:10.1001/jama.285.4.371
Breastfeeding Promotion and Infant Health Outcomes

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.

Adverse Outcomes of Prescription Drug Cost-Sharing

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 medications increased.

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Early Statin Treatment and Survival After Acute MI

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.

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Drug Safety Reporting in Clinical Trials

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.

A 25-Year-Old Woman With Bipolar Disorder

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.

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A Piece of My Mind

"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."

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Contempo Updates

Pharmacology and clinical applications of β-lactam antibiotic and β-lactamase inhibitor combinations.

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Medical News & Perspectives

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.

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Screening to Target TB Skin Testing in Children

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%).

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JAMA 2001 Medical Education Issue

Original research and comprehensive reviews are invited for the annual JAMA medical education issue scheduled for September 2001.

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JAMA Patient Page

For your patients: Information about breastfeeding.

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