1. Section Editor(s): Kennedy, Maureen Shawn MA, RN

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Breastfeeding exclusively for the first six months reduces rates of mother-to-child HIV transmission. New data on HIV transmission have spurred a call for revised breastfeeding guidelines. A study published in the March 31 issue of the Lancet looked at HIV transmission among HIV-positive mothers and their infants in nine KwaZulu-Natal clinics in South Africa (seven rural, one semiurban, one urban). Infants receiving "mixed breastfeeding" (breast milk, non-human milk, other liquids, or solids) were twice as likely as exclusively breastfed infants to be infected by their HIV-positive mothers. Those given solid foods were 11 times more likely to be infected with HIV.


Of the 1,276 infants with complete feeding data, the cumulative mortality rate at three months was 6.1% for exclusively breastfed infants versus 15.1% for infants receiving mixed breastfeeding. The researchers speculate that exclusive breastfeeding protects the infant's intestinal mucosa, creating a more effective barrier to HIV. Solid foods' larger, more complex proteins may damage the gastrointestinal mucosa, enabling the virus to enter between cells, or may alter the regulation of gut receptors, increasing virus absorption and infection.


When HIV infection does not occur during birth and the child isn't breastfed, mother-to-infant transmission doesn't take place. But in low-income countries, breastfeeding can protect infants from other causes of death, preventing perhaps 13% to 15% of infant deaths. The researchers call for revision of infant feeding guidelines, last revised in 2000, from the World Health Organization and the Joint United Nations Programme on HIV/AIDS.


Declare your commitment to improving global health. The Nightingale Initiative for Global Health (NIGH), a nonprofit organization working to improve health from the local to the global level and to promote recognition of nursing's role in health care, is ramping up its efforts with the Nightingale Global Alliance Campaign for a Healthy World. NIGH hopes to encourage the United Nations (UN) to declare 2010 the International Year of the Nurse and 2011 to 2020 the UN Global Decade for a Healthy World by getting 2 million signatories to its Nightingale Declaration of Commitment for a Healthy World by 2020. To sign the declaration and for more information on NIGH, go to

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Almost a quarter of adult community-hospital patients in 2004 had a primary or secondary mental health or substance abuse diagnosis, according to a report from the Agency for Healthcare Research and Quality (available at The most common of these diagnoses were mood disorders, substance abuse disorders, and dementia-delirium. The hospital stays of these patients were less costly, but more often billed to Medicaid or Medicare, than those of patients without these primary or secondary diagnoses.


Reporting patient safety concerns now safe in Colorado. Governor Bill Ritter on March 29 signed the Health Care Worker Whistle-Blower Protection Bill, which prohibits employers from retaliating against workers who go public when complaints registered through internal reporting systems are ignored. Previously, workers who were fired for revealing safety concerns had no legal recourse. Legislators hope the law will improve patient safety and reduce medical errors.