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.
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.
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.
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%.
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.
"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."
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
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.
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.
For your patients: Information about blood pressure problems during
This Week in JAMA . JAMA. 2001;285(12):1545. doi:10.1001/jama.285.12.1545