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This Week in JAMA
March 28, 2001

This Week in JAMA

JAMA. 2001;285(12):1545. doi:10.1001/jama.285.12.1545
Physical Abuse Before, During, and After Pregnancy

To examine patterns of physical abuse before, during, and after pregnancy, Martin and colleaguesArticle used data from the North Carolina Pregnancy Risk Assessment Monitoring System, a population-based mail and telephone survey of North Carolina women who recently delivered live-born infants. The prevalence of abuse among the respondents was 6.9% during the 12 months before pregnancy, 6.1% during pregnancy, and 3.2% during a mean postpartum period of 3.6 months. Almost all respondents took their infants to well-baby care visits. In a commentary, Thompson and KrugmanArticle encourage screening for intimate partner abuse at well-baby visits and urge federal funding for research on family violence.

Gemfibrozil, Lipid Levels, and Coronary Heart Disease

In the Veterans Affairs High-Density Lipoprotein Intervention Trial (VA-HIT), participants treated with gemfibrozil, a fibric acid derivative, had a significant reduction in the combined incidence of nonfatal myocardial infarction and coronary heart disease (CHD) deaths during a mean follow-up of 5 years, associated with an increase in high-density lipoprotein cholesterol (HDL-C), a decrease in triglyceride, and no change in low-density lipoprotein cholesterol (LDL-C) levels. Participants recruited for this study had a history of CHD and low plasma levels of both LDL-C and HDL-C. In further analyses of data from this trial, Robins and colleagues found that the reduction in CHD events was dependent in part on the increased concentrations of HDL-C achieved during treatment, but not on baseline lipid concentrations or levels of triglycerides or LDL-C during treatment.

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Transfusions in Patients With HIV Infection and Anemia

The observation that blood transfusions adversely affect the clinical course of patients infected with HIV has been attributed to immunomodulatory effects of allogeneic leukocytes in red blood cell (RBC) products. In this trial, Collier and colleagues assigned persons infected with HIV and cytomegalovirus (CMV) who required transfusions for anemia to receive either leukocyte-reduced or unmodified RBC transfusions. Trends in survival were better among patients who received unmodified RBCs. HIV RNA levels were stable in both groups at 1 and 4 weeks after transfusion, and there were no significant differences in the occurrence of transfusion reactions, serious HIV-related diseases, new CMV disease, or CMV reactivation.

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Clinical Decision Aid to Discontinue Resuscitation

Survival rates after in-hospital cardiac arrest are low. In a previous study, van Walraven and colleagues derived a clinical decision aid that identified all patients who survived to hospital discharge after a cardiac arrest based on 3 criteria: whether the arrest was witnessed, whether the initial cardiac rhythm was ventricular tachycardia or fibrillation, and whether a pulse was regained during the first 10 minutes of chest compressions. To validate this decision aid, the investigators used data from a registry of 2181 in-hospital cardiac resuscitations at a community teaching hospital. For 327 of these resuscitations, the patient survived to hospital discharge. The decision aid correctly identified 324 of these resuscitations, resulting in a sensitivity of 99.1% and a negative predictive value of 98.9%.

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Endothelial Dysfunction and Preeclampsia

Preeclampsia is thought to result from dysfunction of maternal endothelium damaged by factors released by the placenta after abnormal placentation. To identify whether maternal factors independent of placental factors contribute to endothelial dysfunction in preeclampsia, Chambers and colleagues compared vascular responses of women with previous preeclampsia with those of women with previous uncomplicated pregnancies, all of whom were at least 3 months (median, 3 years) postpartum. Women with previous preeclampsia had impaired flow-mediated (endothelium-dependent) brachial artery dilatation that was reversed by administration of an antioxidant, ascorbic acid, and was not explained by known maternal risk factors, such as hypertension, obesity, and diabetes.

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A Piece of My Mind

"Even though she tries to hide her bare head under wigs and hats and colorful scarves, the pale, doughy face with neither eyebrows nor eyelashes brands her as a cancer patient." From "A Simple Song of Gratitude."

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Medical News & Perspectives

Although computers inspire fear and loathing in many older people, Internet research firms say there is no doubt that seniors will increasingly be searching for health information on the Web, and innovative ways are needed to ease them online.

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Prenatal Cocaine Exposure

A critical systematic review of studies on the growth and development of children born to mothers who used cocaine during pregnancy debunks common beliefs about the toxicity of prenatal cocaine exposure.

Medical Malpractice in Japan

A review and analysis of the evolution and current state of professional liability in Japan and the Japanese system for resolving legal disputes related to medical injury.

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JAMA Patient Page

For your patients: Information about blood pressure problems during pregnancy.

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