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April 26, 2010 — Embargoed ContentJAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives of 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. ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, April 26, 2010)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 26, 2010
Greater Chocolate Consumption May Be Associated With Higher Depression Scores
CHICAGO—Individuals who screen positive for possible depression appear to consume more chocolate than those not screening positive for depression, according to a report in the April 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. "A rich cultural tradition links chocolate consumption with putative mood benefits," the authors write as background information in the article. Several potential mechanisms for these benefits have been proposed, but little scientific research has examined the association between chocolate and mood in humans. Natalie Rose, M.D., of University of California, Davis, and University of California, San Diego, and colleagues examined the relationship between chocolate and mood among 931 women and men who were not using antidepressants. Participants reported how much chocolate they consumed and most also completed a food frequency questionnaire about their overall diet. Their moods were assessed using a previously validated depression scale. Those who screened positive for possible depression consumed an average of 8.4 servings of chocolate per month, compared with 5.4 servings per month among those not screening positive. Those whose scores were even higher, reflecting probable major depression, consumed even more chocolate—11.8 servings per month. Findings were similar among women and men. "Several nutrient factors that could be theorized to drive the appearance of a putative chocolate-mood association, such as caffeine, fat, carbohydrate and energy intake, bore no significant correlation with mood symptoms, suggesting relative specificity of the finding," the authors write. There was also no difference in the consumption of other antioxidant-rich foods—including fish, coffee, caffeine and fruits and vegetables—between the two groups. Several explanations for the findings are possible, the authors note. "First, depression could stimulate chocolate cravings as 'self-treatment' if chocolate confers mood benefits, as has been suggested in recent studies of rats. Second, depression may stimulate chocolate cravings for unrelated reasons, without a treatment benefit of chocolate (in our sample, if there is a 'treatment benefit,' it did not suffice to overcome the depressed mood on average). Third, from cross-sectional data the possibility that chocolate could causally contribute to depressed mood, driving the association, cannot be excluded."
In addition, a physiological factor such as inflammation could drive both depression and chocolate cravings, or more complex relationships may exist. For instance, the mood-elevating, craving-triggering effects of chocolate may be counteracted by ingredients that often accompany chocolate products, including artificial trans fats that inhibit omega-3 fatty acid production. "Future studies are required to elucidate the foundation of the association and to determine whether chocolate has a role in depression, as cause or cure," the authors conclude.
Editor's Note: The procurement of the data was funded by a grant from the National Heart, Lung and Blood Institute, National Institutes of Health, and by the University of California, San Diego General Clinical Research Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 26, 2010
Patients, Clinicians Favor Disclosure of Financial Ties to Industry
CHICAGO—A review and analysis of previously published studies finds that patients, research participants and journal readers believe financial relationships between medicine and industry should be disclosed, in part because those financial ties may influence research and clinical care, according to a report in the April 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. "Financial ties to the pharmaceutical, biotechnology and medical device industries are common in clinical medicine and biomedical research," the authors write as background information in the article. "In clinical care, financial ties affect how physicians prescribe drugs and use devices, and may otherwise influence professional behavior. In research, financial ties have been associated with biased analysis and presentation of data, restrictions on publication and reduced sharing of data. As a result, financial ties have recently received substantial attention from the media and policymakers." Public disclosure of these ties has been recommended or required by medical associations, medical journals, lawmakers, academic medical centers and companies. Despite this demand for disclosure, little is known about how financial information affects decision-making, the authors note. Adam Licurse, B.A., of Yale School of Medicine, New Haven, Conn., and colleagues systematically reviewed 20 original studies assessing the attitudes of patients, research participants and journal readers toward financial disclosures. Of these studies, 11 assessed financial ties and perceptions of quality. "In clinical care, patients believed financial ties decreased the quality and increased the cost of care," the authors write. "In research, financial ties affected perceptions of study quality. In two studies, readers' perceptions of journal article quality decreased after disclosure of financial ties." Eight studies evaluated the acceptability of financial ties. In these studies, patients were more likely to view personal gifts to clinicians as unacceptable than professional gifts. "Patients were concerned that these gifts affect the cost and quality of care and that these gifts influence clinical judgment," the authors write. In six of 10 studies examining the importance of disclosure, most patients and research participants reported believing financial ties should be disclosed. In the other four, about one-fourth of these populations believed ties should be disclosed. "Although many disclosure recipients want to know about financial ties, fewer believed that disclosure would affect their decision-making," the authors continue. "Most research participants were not concerned about physician financial ties with industry, with as few as 7 percent reporting concern in one study."
"As information on physician and researcher financial ties becomes more publicly available, further research is needed to explore the optimal format for widespread consumer use and the effect on patient decision-making in clinical care and research," they conclude.
Editor's Note: Co-author Dr. Joffe served as a paid member of a Data and Safety Monitoring Committee for a Genzyme Corporation clinical trial. Dr. Gross has served as an expert witness. This study was supported by a Doris Duke Clinical Research Fellowship. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Disclosure Aids Transparency in Medicine
"During the past decade, a legion of biomedical ethicists, medical students, journalists and elected officials have demanded increased openness in the form of public reporting of financial relationships at the institutional, state and national level," writes Eric G. Campbell, Ph.D., of the Institute for Health Policy, Massachusetts General Hospital, Boston, in an accompanying editorial.
"From a policy perspective, it seems likely that public disclosure is a first step toward a more active role by government and health care institutions in evaluating and managing physician-industry relationships," Dr. Campbell writes. "In the least, these relationships will no longer be a part of the hidden culture of medical practice in the United States, and this transparency will help prevent the further erosion of public trust in the medical profession."
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 26, 2010
Four Unhealthy Behaviors Combine to Increase Death Risk
CHICAGO—Four unhealthy behaviors—smoking, lack of physical activity, poor diet and alcohol consumption—appear to be associated with a substantially increased risk of death when combined, according to a report in the April 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. "Several studies have shown that specific health behaviors, including cigarette smoking, physical inactivity, higher alcohol intake and, to a lesser extent, diets low in fruits and vegetables, are associated with an increased risk of cardiovascular disease, cancer and premature mortality [death]," the authors write as background information in the article. Most studies that examine the effects of these behaviors control for other unhealthy behaviors to identify independent effects. However, several poor lifestyle choices may coexist in the same individual. "To fully understand the public health impact of these behaviors, it is necessary to examine both their individual and combined impact on health outcomes," write Elisabeth Kvaavik, Ph.D., of University of Oslo, Norway, and colleagues. The researchers interviewed 4,886 individuals age 18 or older in 1984 to 1985. "A health behavior score was calculated, allocating one point for each poor behavior: smoking; fruits and vegetables consumed less than three times daily; less than two hours physical activity per week; and weekly consumption of more than 14 units [one unit equals 8 grams, or about 0.3 ounces] of alcohol (in women) and more than 21 units (in men)." During an average of 20 years of follow-up, 1,080 participants died—431 from cardiovascular disease, 318 from cancer and 331 from other causes. When compared with participants who had no poor health behaviors, the risk of death from all causes and from each cause increased with each additional behavior. Individuals with four compared with zero poor health behaviors had about three times the risk of dying of cardiovascular disease or cancer, four times the risk of dying from other causes and an overall death risk equivalent to being 12 years older.
"Modest but achievable adjustments to lifestyle behaviors are likely to have a considerable impact at both the individual and population level," the authors conclude. "Developing more efficacious methods by which to promote healthy diets and lifestyles across the population should be an important priority of public health policy."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 26, 2010
Interruptions Associated With Medication Errors by Nurses
CHICAGO—Nurses who are interrupted while administering medication appear to have an increased risk of making medication errors, according to a report in the April 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Laboratory studies have demonstrated that interruptions during a task contribute to inefficiency and errors, the authors write as background information in the article. "Experimental studies suggest that interruptions produce negative impacts on memory by requiring individuals to switch attention from one task to another," the authors write. "Returning to a disrupted task requires completion of the interrupting task and then regaining the context of the original task." Medication errors occur as often as once per patient per day in some settings, and approximately one-third of harmful medication errors are thought to occur during medication administration. Johanna I. Westbrook, Ph.D., of the University of Sydney, Australia, and colleagues studied nurses preparing and administering medications in six wards of two major teaching hospitals. Interruptions were noted and two types of errors were tracked: procedural failures, including failure to read labels, check patient identification or record administration on medication chart; and clinical errors, including wrong drug, dose, formulation or strength. The 98 nurses were observed while preparing and administering 4,271 medications to 720 patients over 505 hours from September 2006 through March 2008. Only 19.8 percent of these administrations were free of both kinds of errors. At least one procedural failure occurred in 74.4 percent of administrations and at least one clinical failure in 25 percent. Interruptions occurred during 53.1 percent of administrations. "Each interruption was associated with a 12.1 percent increase in procedural failures and a 12.7 percent increase in clinical errors," the authors write. When nurses were not interrupted, procedural failure rates were 69.6 percent and clinical error rates were 25.3 percent, compared with procedural failure rates of 84.6 percent and clinical error rates of 38.9 percent if they were interrupted three times. In addition, errors became more severe as the number of interruptions increased. "Without interruption, the estimated risk of major error was 2.3 percent; with four interruptions this risk doubled to 4.7 percent," the authors write. "The converging evidence of the high rate of interruptions occurring during medication preparation and administration adds impetus to the need to develop and implement strategies to improve communication practices and to reduce unnecessary interruptions within ward environments," the authors write. "While it is clear that some interruptions are central to providing safe care, there is a need to better understand the reasons for such high interruption rates."
Simple strategies to reduce interruptions could include easy access to whiteboards or other sources of information, along with having nurses wear vests with "do not interrupt" messages on them while conducting medication rounds, the authors note.
Editor's Note: The research was supported by a grant from the Health Contribution Fund Health and Medical Research Foundation of Australia, and grants from the National Health and Medical Research Council. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org. |
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