JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, March 22, 2005)
JAMA NEWS RELEASES
STUDY FINDS FACTORS LINKED TO SUBSTANCE USE DISORDER RELAPSE AMONG HEALTH CARE PROFESSIONALS
THREE-YEAR CERVICAL CANCER SCREENING RECOMMENDATIONS MAY BE APPLICABLE FOR CERTAIN WOMEN WITH HIV
SUDAN SURVEYS SHOW HIGH RATES OF DEATH AND MALNUTRITION AMONG DISPLACED POPULATION
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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Embargoed for Release: 3 p.m. CT, TUESDAY, March 22, 2005
Media Advisory: To contact Karen B. Domino, M.D., M.P.H., call Pam Sowers at 206/685-4232. To contact editorialist David R. Gastfriend, M.D., call 617-583-6061.
STUDY FINDS FACTORS LINKED TO SUBSTANCE USE DISORDER RELAPSE AMONG HEALTH CARE PROFESSIONALS
CHICAGO—Having a coexisting psychiatric illness or family history of a substance use disorder or having used a major opioid are key factors that can increase the likelihood of a substance use disorder relapse among health care professionals, according to a study in the March 23/30 issue of JAMA.
The prevalence of chemical dependency (excluding nicotine) among physicians has been estimated to be 10 percent to 15 percent, similar to that in the general population, according to background information in the article. Following completion of primary treatment, recovery is best achieved through continuing group therapy and regular attendance at mutual help groups. Data on the incidence of relapse and risk factors contributing to the likelihood of relapse after initial treatment for substance use are lacking.
Karen B. Domino, M.D., M.P.H., of the University of Washington, Seattle, and colleagues conducted a study to identify factors that might predispose individuals to relapse. The study included 292 health care professionals enrolled in the Washington Physicians Health Program, an independent post-treatment monitoring program. The participants were followed up between January 1, 1991, and December 31, 2001.
Twenty-five percent (74 of 292 individuals) had at least 1 relapse. The researchers found that a family history of a substance use disorder increased the risk of relapse (2.3 times greater risk). The use of a major opioid (e.g., fentanyl, sufentanil, morphine, meperidine) increased the risk of relapse significantly in the presence of a coexisting psychiatric disorder (5.8 times increased risk) but not in the absence of a coexisting psychiatric disorder. The presence of all 3 factors-major opioid use, dual diagnosis (presence of a coexisting psychiatric disorder), and family history-markedly increased the risk of relapse (13.3 times). The risk of subsequent relapses increased after the first relapse (1.7 times increased risk).
"In health care professionals with a substance use disorder, the presence of a coexisting psychiatric illness or a family history of substance use disorder significantly increased the likelihood of relapse, as did the presence of prior relapse," the authors write. "Use of major opioids also increased risk of relapse in the presence of family history and even more dramatically in those with a dual diagnosis, and the combination of all 3 risk factors further magnified the likelihood of relapse. State physician health programs might wish to consider managing substance-using professionals who have one or more of these 3 risk factors and those with prior relapse with more intensive and more prolonged monitoring."
(JAMA. 2005;293:1453-1460. Available post-embargo at jama.com)
EDITORIAL: PHYSICIAN SUBSTANCE ABUSE AND RECOVERY - WHAT DOES IT MEAN FOR PHYSICIANS-AND EVERYONE ELSE?
In an accompanying editorial, David R. Gastfriend, M.D., formerly of Massachusetts General Hospital and Harvard Medical School, Boston, discusses the findings by Domino et al.
"It remains to be seen how improved detection and better-matched recovery planning will address those with the doubled relapse risk of dual diagnosis and the multifold risk of the triple-threat: dual diagnosis, opioid dependence, and family history. These data suggest that analyzing the trajectories of recovering physicians may improve the knowledge base for anticipating and matching the needs of physicians entering recovery. But retrospective cohort analyses from single states using clinically derived data, while better than no data at all, are inadequate in this millennium. Better data are needed, such as multi-state data from prospective studies with research quality instrumentation. It is time for physician health programs to become formal research programs, or better yet, to form a national research program."
"Individualized monitoring plans and treatment contracts that take into account various risk loadings should improve outcomes for patients with substance use disorders. Success from substance use disorder treatment should be sought and expected not just for physicians but for every patient-but only if the conditions available for physician recovery can be provided to all. These 'ifs' are pivotal: if intervention occurs early, if structure is provided as well as support, if treatment resources are provided as if a life and career matter, and if close monitoring and treatment matching are provided with active treatment intervention and escalation to meet the clinical need. Surely this type of care is costly. Why should such high-quality care be provided? Because a brain disease that subverts self-preservation is a disease nonetheless, and helping patients recover from this disease can save lives, families, and productive careers," Dr. Gastfriend concludes.
(JAMA. 2005;293:1513-1515. Available post-embargo at jama.com)
Editor's Note: Dr. Gastfriend is now vice president of medical affairs, Alkermes Inc., Cambridge, Mass. He receives support through a grant from the National Institute on Drug Abuse.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, TUESDAY, March 22, 2005
Media Advisory: To contact Tiffany G. Harris, Ph.D., call Karen Gardner at 718-430-3101.
THREE-YEAR CERVICAL CANCER SCREENING RECOMMENDATIONS MAY BE APPLICABLE FOR CERTAIN WOMEN WITH HIV
CHICAGO—Women with human immunodeficiency virus (HIV) who have normal cervical cancer screening results and negative tests for human papillomavirus (HPV), a sexually transmitted virus that is associated with cervical cancer, may be able to have Papanicolaou (Pap) smears every three years, the same interval as HIV-negative women, according to a study in the March 23/30 issue of JAMA.
According to background information in the article, "cervical cancer screening recommendations in the United States have been recently updated and now advise using an interval of 3 years between screenings in healthy women 30 years or older who have normal cytology (cells) results and who test negative for oncogenic (cancer-associated) human papillomavirus (HPV) DNA. The recommended interval is 6 to 12 months for women with normal cytology and detectable oncogenic HPV." Women who are HIV-positive are recommended to have two Pap smears six-months apart after their initial HIV diagnosis, and if both are normal, should undergo an annual screening. HPV test results are not considered.
Tiffany G. Harris, Ph.D., from Albert Einstein College of Medicine, Bronx, N.Y., and colleagues studied the incidence of cervical squamous intraepithelial lesions (SILs) [abnormal lesions] among HIV-seropositive (n= 855) and HIV-seronegative (n= 343) who were enrolled in the Women's Interagency HIV Study (WIHS) and had normal cervical cytology at the beginning of the study. The researchers sought to determine if a single initial HPV test result could be used to determine the appropriate cervical cancer screening interval in an HIV-seropositive woman with normal cervical cytology.
The researchers found that after two years, "there were no large or significant absolute differences in the cumulative incidence of SIL" between the two groups of women. "In this observational cohort study, HIV-seronegative and HIV-seropositive women who had normal cytology results with CD4 (cell) counts greater than 500/microlitre and who had negative test results for HPV at baseline had a similar low cumulative incidence of any SIL for 3 years or more," the researchers report.
In conclusion the authors write: "Consideration will also need to be given to the psychosocial costs of a positive HPV test in HIV-seropositive women, many of whom will not develop SIL. However, according to the results of our study, we believe that the use of HPV testing in HIV-seropositive women warrants evaluation in a formal clinical trial."
(JAMA. 2005;293:1471-1476. Available post-embargo at jama.com)
Editor's Note: The WIHS is funded by the National Institute of Allergy and Infectious Diseases with supplemental funding from the National Cancer Institute and the National Institute on Drug Abuse. Funding is also provided by the National Institute of Child Health and Human Development and the National Center for Research Resources.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3 p.m. CT, TUESDAY, March 22, 2005
Media Advisory: To contact corresponding author Frances Sanderson, M.D., Ph.D., email: frances.sanderson@imperial.ac.uk.
SUDAN SURVEYS SHOW HIGH RATES OF DEATH AND MALNUTRITION AMONG DISPLACED POPULATION
CHICAGO—An assessment of the people living in three communities in South Darfur, Sudan found a high number of deaths from violence and disease, according to a brief report in the March 23/30 issue of JAMA.
In background information, the authors write mass violence against civilians in the west of Sudan started in 2003 and has continued. "More than 1.5 million people (25 percent of the population of the region) are now scattered in 127 encampments in Darfur and 15 in neighboring Chad," the authors note. "Médecins Sans Frontières (MSF) began work in West Darfur in December 2003, and operations in South Darfur, including feeding centers and primary care clinics, opened n May 2004 and have been centered on 3 sites." The three sites are Kass, Kalma, and Muhajiria, South Darfur.
Francesco Grandesso, M.Sc., and colleagues from Médecins Sans Frontières, analyzed the results of surveys conducted in August and September 2004 in the three sites among 137,000 internally displaced persons to assess health and nutritional status for the relief efforts in those area. At each site, general household status, number of deaths among adults and children, and nutritional and vaccination status of children aged 6 months to almost 5 years were assessed. A questionnaire detailing access to food and basic services was administered to a subset of households (n= 210 in each site).
"Two hundred seventeen deaths were reported over the previous 121 days in Kass; and in Kalma and Muhajiria, there were 30 and 36 deaths over the 30 days prior to the survey," the authors found. "The crude mortality (death) rates at all 3 sites were considerably higher than the 1 per 10,000 per day that is recognized internationally as defining an emergency situation and 4 to 6 times the expected rate in sub-Saharan populations. In Kass and Kalma, the under 5-year mortality rates exceeded the 2 per 10,000 per day used as the emergency benchmark." Deaths from medical causes predominated in Kass and Kalma with diarrheal diseases responsible for many of those deaths affecting mainly young children under 5 and adults older than 50. "Violence was the major cause of death in Muhajiria (72 percent), with all but one of the 25 violent deaths in men."
"The prevalence of acute malnutrition was high, particularly in Kalma where nearly 24 percent of children younger than 5 years were affected. Reported measles vaccination coverage ranged from 46 percent to 70 percent." The surveys also found that even if households had access to food and nonfood items, many still lacked access to safe water and sanitation.
"Additional efforts from humanitarian and governmental actors are urgently needed to guarantee acceptable living standards for these populations," the authors conclude.
(JAMA. 2005;293:1490-1494. Available post-embargo at jama.com)
Editor's Note: This study was supported by Médecins Sans Frontières, Amsterdam, the Netherlands. Nutrition kits used for height and weight assessment were donated by the United Nations Children's Fund.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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