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This Week in JAMA
March 23/30, 2005

This Week in JAMA

JAMA. 2005;293(12):1419. doi:10.1001/jama.293.12.1419
Substance Abuse Relapse in Health Care Professionals

To determine the incidence and factors associated with relapse after initial treatment for substance abuse among health care professionals, Domino and colleaguesArticle reviewed data from individuals enrolled in a posttreatment monitoring program. During 11 years of follow-up, 1 or more relapses were documented in 74 individuals. Abuse of a major opioid and a coexisting psychiatric illness or a family history of a substance abuse disorder were associated with an increased risk of relapse. In an editorial, GastfriendArticle discusses the implications of these findings for treatment of patients with substance use disorders.

Exposure Level, Age, and Severity of Malaria

In a prospective study in Tanzania, Reyburn and colleagues examined patterns of severe malaria and mortality and the relationship to age in areas of high, moderate, and low transmission of Plasmodium falciparum to elucidate possible long-term consequences of malaria control efforts that delay immune acquisition. Increasing odds of severe malarial anemia were associated with younger age, and increasing odds of cerebral malaria were associated with older age and residence in areas with low levels of transmission. Respiratory distress was not associated with age or transmission level. Mortality curves were J-shaped, with lowest mortality among children 3 to 4 years of age.

Cervical Cancer Screening and HIV and HPV Status

Current recommendations for cervical cancer screening in women infected with the human immunodeficiency virus (HIV) do not take into account human papillomavirus (HPV) status. In a prospective study, Harris and colleagues determined the incidence of squamous intraepithelial lesions (SILs) according to baseline HPV DNA results and stratified by HIV serostatus and CD4 T-cell count. They found a similar low incidence of any SILs among HIV-seronegative and HIV-seropositive women with CD4 counts greater than 500/μL, who had normal cervical cytology, and HPV-negative test results.

Prevention of Vasospasm With Nitrite

Delayed cerebral vasospasm develops in half of patients receiving surgical or endovascular treatment of a ruptured aneurysm. Pluta and colleagues report that intravenous sodium nitrite prevented development of delayed cerebral vasospasm in a primate model.

Genotype and Treatment Response in ALL

Stanulla and colleagues assessed the association of thiopurine methyltransferase (TPMT) genotype with minimal residual disease load—a prognostic measure—before and after a cycle of mercaptopurine as part of multiagent chemotherapy in childhood acute lymphoblastic leukemia (ALL). They found that patients with allelic variants of TPMT conferring lower enzyme activity had higher rates of residual disease after treatment.

Mortality and Malnutrition in South Darfur, Sudan

Grandesso and colleagues report results of mortality and nutritional status surveys conducted in September 2004 among internally displaced persons at 3 sites in South Darfur, Sudan. Crude mortality rates exceeded 1 per 10 000 per day, the internationally recognized definition of “very serious.” Acute malnutrition was common, affecting between 10.7% and 23.6% of the populations surveyed.

A Piece of My Mind

“What did they do for you, young Jahi, when malaria coursed through your body like a runaway train?” From “Jambo, Jahi.”

Medical News & Perspectives

Expanded use of a new conjugate vaccine in children, adolescents, and college freshmen is expected to markedly reduce the prevalence of invasive meningococcal disease in the United States.

Survival of Academic Medical Centers

Factors that prevented the demise of academic medical centers and are crucial to their future success.


Drug-eluting stents, glycoprotein IIb/IIIa inhibitors, and advances in therapy modify revascularization outcomes.

Inhibitors of Ocular Neovascularization

New therapies for proliferative retinopathies offer promise, with potential shortcomings.

JAMA Patient Page

For your patients: Information about malaria.