Zidovudine monotherapy became the standard of care for reduction of
maternal-infant transmission of human immunodeficiency virus (HIV) when its
efficacy was demonstrated in 1994. Mandelbrot and colleaguesArticle report that the
transmission rate in a prospective cohort of women and their newborns who
received lamivudine in addition to standard zidovudine prophylaxis was 1.6%
compared with a transmission rate of 6.8% in a historical cohort who received
zidovudine monotherapy. Combination prophylaxis, however, was associated with
resistance to lamivudine and the occurrence of neutropenia and anemia, but
the frequency of moderate-to-severe hematologic toxicity was not significantly
different from that in the historical comparison group. In an editorial, ShafferArticle
discusses possible prophylactic strategies suggested by these findings to
reduce vertical HIV transmission in both developed and developing countries.
In this analysis of data from a survey of US youth in grades 6 through
10, Nansel and colleaguesArticle found that 29.9% of the sample reported moderate
or frequent involvement in bullying as a bully, being bullied, or both. Children
involved in bullying demonstrated poorer psychosocial adjustment than children
who did not report involvement with bullying. In an editorial, Spivak and
Prothrow-StithArticle consider the possible relationship of bullying to youth violence
and discuss approaches to prevention and intervention.
To determine whether differences in invasive procedure rates alone account
for observed outcome differences in patients with acute myocardial infarction
(MI) admitted to hospitals with or without on-site revascularization facilities,
Alter and colleagues evaluated outcomes of patients hospitalized with acute
MI, controlling for other hospital characteristics and also for patient and
physician characteristics. Patients admitted to hospitals with on-site revascularization
facilities were much more likely to undergo revascularization. Five-year mortality
rates were similar in the 2 groups, but nonfatal 5-year cardiac event rates
were significantly lower among patients admitted to hospitals with on-site
revascularization facilities. Differences in nonfatal outcomes were explained
primarily by hospital teaching status and not by differences in cardiac intervention
The risk of type 2 diabetes mellitus (DM) is increased among individuals
with impaired glucose tolerance, but the risk of developing diabetes among
persons with normal or impaired fasting glucose levels is not known. The Hoorn
Study is a population-based cohort study on glucose intolerance in a general
Dutch elderly population that began in 1989. de Vegt and colleagues report
that over a period of 6 years, the cumulative incidence of type 2 diabetes
was higher among individuals with impaired fasting glucose and impaired glucose
tolerance at baseline than among individuals with a normal fasting glucose
level, and highest among those with both impaired fasting glucose and impaired
To determine the rate of medication errors in pediatric inpatient settings,
Kaushal and colleagues reviewed 10 778 medication orders for 1120 patients
admitted to 2 pediatric academic institutions during a 6-week period. The
investigators identified 616 (5.7%) medication errors, 115 (1.1%) potential
adverse drug events (ADEs), and 26 (0.24%) ADEs, 5 of which were preventable.
Most potential ADEs occurred at the stage of drug ordering. Physician reviewers
and ward-based clinical pharmacologists estimated that computerized physician
order entry could potentially have prevented 93% to 94% of potential ADEs.
New research on the nitric oxide pathway and regulation of vasomotor
tone is elucidating potential novel antihypertensive drug targets.
Pediatric dermatology is a growing subspecialty that focuses on many
disorders unique to children. New approaches to the management of dermatologic
problems in children were presented at the annual meeting of the American
Academy of Dermatology.
Mrs T describes symptoms of obsessive-compulsive disorder (OCD) beginning
in early childhood. She has also experienced episodes of severe depression
requiring hospitalization. Jenike discusses diagnostic criteria for OCD, pathophysiology,
For your patients: Information about bullying.
This Week in JAMA . JAMA. 2001;285(16):2049. doi:10.1001/jama.285.16.2049