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This Week in JAMA
November 3, 1999

This Week in JAMA

JAMA. 1999;282(17):1601. doi:10.1001/jama.282.17.1601
New Editor of JAMA

Catherine D. DeAngelis, MD, MPH , is named new Editor of JAMA and Editor-in-Chief of the AMA Scientific Information and Multimedia Group. Dr DeAngelis is currently Vice Dean for Academic Affairs and Faculty and professor of pediatrics at Johns Hopkins University School of Medicine and Editor of the Archives of Pediatrics & Adolescent Medicine.

Catherine D. DeAngelis, MD, MPH

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JAMA-EXPRESS: HIV Persists Despite HAART; CMV Risk Still Declines

Using an ultrasensitive reverse transcriptase polymerase chain reaction analysis, Dornadula and colleaguesArticle found that human immunodeficiency virus (HIV) RNA (mean level, 17 copies/mL) was detectable in the peripheral blood plasma of 22 patients who were receiving suppressive highly active antiretroviral therapy (HAART) and who had fewer than 50 copies/mL of plasma HIV RNA by standard assays. Despite the likely persistence of low-level HIV replication in patients taking suppressive HAART, in a study of 14 patients with acquired immunodeficiency syndrome and inactive cytomegalovirus (CMV) retinitis who were being treated with HAART and systemic anti-CMV medications and who had CD4+cell counts greater than 0.15 × 109/L, Whitcup and colleagues foundArticle that all of the patients were able to discontinue maintenance anti-CMV therapy without reactivation of retinitis during a mean follow-up of 16.4 months. In an editorialArticle, D'Aquila and Walker discuss the benefits and limitations of HAART.

Prognostic Criteria Inadequate for Hospice Eligibility

A prognosis for survival of less than 6 months often determines eligibility for hospice care for patients with advanced chronic diseases. In this validation study of prognostic criteria for hospice enrollment, however, Fox and colleagues found that among 2607 patients with advanced chronic obstructive pulmonary disease, congestive heart failure, or end-stage liver disease, 70% of 923 patients predicted to have a survival of 6 months or less according to broad inclusion criteria (similar to National Hospice Organization guidelines) survived more than 6 months after hospital discharge. In an editorial, Finucane describes the complex and difficult transition for patients with advanced disease from being gravely ill but fighting death to a state of dying and seeking to preserve comfort and dignity.

See Article and editorial Article

Placental Abruption and Poor Perinatal Outcomes

Pregnancies complicated by placental abruption have been associated with increased risk of low birth weight, stillbirth, preterm delivery, and perinatal death. In this retrospective study, Ananth and colleagues found that placental abruption complicated 530 (1%) of 53,371 pregnancies in 40,789 women. Compared with pregnancies without abruption, placental abruption had an adjusted relative risk of 8.9 for stillbirth, 3.9 for preterm delivery, 4.6 for low birth weight, and 2.0 for fetal growth restriction. Stillbirth was significantly associated with more severe abruption (≥50%), but preterm delivery was significantly associated with even mild abruption.

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Adverse Childhood Events and Smoking Risk as Adults

Using data from 9215 adult respondents in the Adverse Childhood Experiences Study mail survey questionnaire, Anda and colleagues found that exposure to each of 8 categories of adverse psychosocial childhood events was associated with an increased risk of early smoking initiation, ever smoking, current smoking, and heavy smoking. The risk of each smoking behavior increased as the reported number of categories of adverse event exposure increased.

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Energy Homeostasis in Nonalcoholic Steatohepatitis

To determine whether nonalcoholic steatohepatitis is associated with impaired liver energy homeostasis, which may explain progression from steatohepatitis to progressive liver fibrosis and cirrhosis, Cortez-Pinto and colleagues studied the response of 8 adult patients with biopsy-proven nonalcoholic steatohepatitis and 7 healthy control subjects to fructose-induced hepatic ATP depletion. Preinfusion and minimum postinfusion liver ATP levels were similar in the 2 study groups, but liver ATP levels were significantly lower in the patient group 1 hour after the infusion. Body mass index correlated inversely with ATP recovery in both patient and control groups.

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A Piece of My Mind

"If I were to die tomorrow, what stories would my child remember me by?" From "Lisa's Stories."

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Medical News & Perspectives

Vision researchers are working on methods to avert the need for elderly individuals to relinquish the keys to the family car.

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Health Care Since 1930

Looking back over 70 years, Eli Ginzberg reflects on his major encounters with the US health care sector.

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A forum on the ethics of intentional diagnostic miscoding by physicians.

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JAMA Patient Page

For your patients: Teenage smoking.

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