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This Week in JAMA | May 1, 2013|

This Week in JAMA FREE

JAMA. 2013;309(17):1749. doi:10.1001/jama.2013.4398.
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CHILD HEALTH

A JAMA THEME ISSUE

Edited by Jody Zylke, MD; Frederick Rivara, MD, MPH; and Howard Bauchner, MD

VITAMIN D SUPPLEMENTATION IN HEALTHY INFANTS

To investigate the efficacy of different doses of vitamin D in supporting target 25-hydroxyvitamin D (25[OH]D) concentrations in nursing infants, Gallo and colleagues randomly assigned 132 breastfed infants to receive vitamin D3 supplements of 400, 800, 1200, or 1600 IU/d for 3 months. The authors report that only the 1600 IU/d dosage increased plasma 25[OH]D concentration to 75 nmol/L or greater in 97.5% of the infants—the primary trial outcome. However, this dosage increased plasma 25[OH]D concentration to levels associated with hypercalcemia. In an editorial, Abrams discusses vitamin D supplementation for infants.

IMMUNOGENICITY OF 2 DOSES OF HPV VACCINE

In a randomized, age-stratified, immunogenicity study involving 830 girls and young women, Dobson and colleagues found that human papillomavirus (HPV) antibody titers—assessed 1 month after the last quadrivalent vaccine dose—in girls aged 9 through 13 years who received 2 vaccine doses were noninferior to titers among young women aged 16 through 26 years who received 3 vaccine doses. In an editorial, Kahn and Bernstein discuss the immunogenicity and efficacy of a 2-dose vaccine schedule.

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ANTIRETROVIRAL REGIMENS AND VIROLOGICAL FAILURE

Efavirenz and nevirapine are common components of first-line antiretroviral regimens in human immunodeficiency virus (HIV) infection. Lowenthal and colleagues assessed the comparative effectiveness of these 2 medications in 804 Botswana children (aged 3 to 16 years) infected with HIV and found that use of efavirenz compared with nevirapine as initial antiretroviral treatment was associated with significantly less virological failure.

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NEURODEVELOPMENT OF VERY PRETERM INFANTS

Serenius and colleagues assessed neurodevelopmental outcomes in a cohort of 491 extremely preterm Swedish infants (<27 weeks' gestation) who survived to (corrected) age 2.5 years and compared them with sex-, ethnicity-, and municipality-matched singleton controls born at term. Among their findings were that 73% of the children born extremely preterm and receiving active perinatal care had no or mild disability and outcomes improved with each additional week of gestation.

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GENE VARIANTS IN NEONATAL ABSTINENCE SYNDROME

In an investigation that involved genotyping DNA samples from 86 infants who had in utero exposure to maternal methadone or buprenorphine and were at risk of neonatal abstinence syndrome, Wachman and colleagues found that infants having certain variants in the OPRM1 and COMT genes had a shorter hospital stay and less need for opioid withdrawal treatment.

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CLINICIAN'S CORNER

JAMA Clinical Challenge

A 16-year-old girl had a 3-month history of abdominal pain and swelling, urinary frequency, and unintentional weight gain. On examination, her abdomen was firm, nontender, and without palpable masses. A urine pregnancy test was negative. Abdominal radiography revealed displaced bowel and upper abdominal solid viscera. What would you do next?

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MEDICAL NEWS & PERSPECTIVES

Efforts are under way to help school staff recognize signs of mental health problems among children and adolescents and refer at-risk students for treatment.

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VIEWPOINTS

Restoring science to the National Children's Study

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Shedding light on childhood adversity

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Transforming child health research

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Creation and retention of future child health physician-scientists

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A PIECE OF MY MIND

“[B]y preventing so many of Nature's cruelties with medicine, I believe we have slowly started to ‘trust’ it again, even to long for it to the exclusion of modernity.” From “What Is Natural?”

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EDITORIAL

Contrasts in child health and child health research

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AUTHOR IN THE ROOM TELECONFERENCE

Join Justin B. Dimick, MD, MPH, Wednesday, May 15, from 2 to 3 PM eastern time to discuss bariatric surgery complications before and after establishing centers of excellence for the procedure. To register, go to http://www.ihi.org/AuthorintheRoom.

JAMA PATIENT PAGE

For your patients: Information about attention-deficit/hyperactivity disorder.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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