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To contact Randall S. Stafford, M.D., Ph.D., call Sara Selis 650/723-7798.

STUDY DOCUMENTS NATIONAL TRENDS IN USE OF ANTIOBESITY MEDICATIONS

CHICAGO—The use of antiobesity drugs peaked in 1997 and decreased after the withdrawal of fenfluramine-phentermine combination therapy (fen-phen, a prescription appetite suppressant) from the market (in 1997 after reports that it was associated with heart problems), and now remains above early 1990 levels, according to an article in the May 12 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to background information in the article, obesity (defined as a body mass index, or BMI of 30 or more) has increased steadily in the United States from 15 percent in 1976 to 27 percent in 2000. Obesity contributes to several health problems including type 2 diabetes mellitus, hypertension, congestive heart failure, lipid disorders, arthritis and some cancers. The frustration of patients and physicians with unsuccessful weight loss using lifestyle changes (including diet and exercise) makes medication an attractive option, write the authors of the article.

In the mid-1990s, researchers became aware that the diet drug combination fen-phen was highly effective in helping people lose weight and fen-phen fueled tremendous interest in antiobesity medications. Beginning in 1996, reports of pulmonary hypertension and then heart valve abnormalities associated with fen-phen and dexfenfluramine (an active ingredient of fenfluramine) led to the withdrawal of fenfluramine and dexfenfluramine in September 1997. However, several other antiobesity medications were available.

Randall S. Stafford, M.D., Ph.D., of the Stanford Center for Research in Disease Prevention, Palo Alto, Calif., and colleagues investigated the use of antiobesity medication use before, during and after the 1997 withdrawal of fen-phen from the market. The researchers used data from the National Disease and Therapeutic Index (NDTI) from 1991 to 2002. The data included a sample of 13,452 patient visits for which a diagnosis of obesity was made.

The researchers found that in the second quarter of 1997, 2.5 million Americans were taking antiobesity medications, a 4-fold increase over the previous 2 years. Although antiobesity medication use diminished following the withdrawal of fen-phen, current levels of use remain above those in the early 1990s. Phentermine has been the most commonly used antiobesity medication, and in 2002, 31 percent of drug-treated obese patients used phentermine.

The researchers also found that newly released medications including orlistat (used by 0.6 million patients) and sibutramine hydrochloride (used by 0.4 million patients) were used less often, and that most antiobesity medication use occurs in patients without other reported medical problems.

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To contact Richard A. Perugini, M.D., call Alison Duffy at 508/856-2000.

SEVERAL FACTORS CONTRIBUTE TO COMPLICATIONS FOLLOWING WEIGHT LOSS SURGERY

CHICAGO—Surgeon experience, and sleep apnea and hypertension in patients are associated with complications after laparoscopic Roux-en-Y gastric bypass (RYGB) surgery, a procedure to aid in weight loss by surgically attaching a loop of the small intestine to the stomach, allowing food to bypass the stomach and part of the intestinal tract, according to an article in the May issue of The Archives of Surgery, one of the JAMA/Archives journals.

Obesity is a major health problem in the United States, and is estimated to account for approximately 280,000 deaths per year, according to information in the article. Obesity is associated with many other health risks, including hypertension and type 2 diabetes mellitus. RYGB surgery is one of the most commonly offered surgical procedures for the treatment of obesity and appears to offer the best long-term results.

Richard A. Perugini, M.D., of the University of Massachusetts Medical School, Worcester, Mass., and colleagues obtained data on at 188 patients with severe obesity who met the National Institutes of Health guidelines for undergoing RYGB surgery. The researchers recorded all complications that required intervention, and the amount of weight lost in the year following surgery.

The researchers found that of the 188 patients, 50 (26.6 percent) developed complications that required an invasive therapeutic intervention, including two deaths. The researchers identified surgeon experience, sleep apnea, and hypertension as predictors of complications. The most common complication requiring intervention was stricture of the gastrojejunal anastomosis (narrowing at the site where the loop if small intestine is attached to the stomach) occurring in 27 patients (14.4 percent). Weight loss data were available for 93 patients (81 percent). The BMI of these patients dropped from an average of 53 before surgery to 35 at one year after surgery. The average percentage of excess body weight lost after one year was 61 percent. The researchers also found that diabetes mellitus was negatively correlated with percentage of excess body weight lost after one year.

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To contact D. Kay Blanchard, M.D., Ph.D., call Mary Lawson at 507/266-0810.

SENTINEL LYMPH NODE BIOPSY IS ACCURATE FOR STAGING BREAST CANCER, HAS FEWER COMPLICATIONS THAN MORE EXTENSIVE NODE BIOPSY PROCEDURE

CHICAGO—Sentinel lymph node (SLN) biopsy is useful for staging breast cancer and is associated with fewer complications than more extensive axillary lymph node dissection, which has been considered the standard procedure for staging breast cancer, according to an article in the May issue of The Archives of Surgery, one of the JAMA/Archives journals.

Axillary lymph node metastasis (spreading of cancerous cells associated with breast cancer to the axillary lymph node), is an important indicator of the stage to which the breast cancer has progressed, according to information in the article. ALND (removal of all of the axillary lymph nodes) is associated with complication rates of 20 percent to 55 percent, including arm lymphedema (swelling of the tissues of the arm), nerve damage, hemorrhage (bleeding) and localized swelling. Previous studies suggest that SLN biopsy may be a better approach for staging because it involves removal of the first lymph node that receives lymphatic drainage from a breast cancer.

D. Kay Blanchard, M.D., Ph.D., of the Mayo Clinic, Rochester, Minn., and colleagues compared the complications and spread of cancer in women who underwent SLN alone to women who underwent both SLN and ALND.

Women with primary invasive breast cancer (n=1,253) who underwent SLN biopsy between October 14, 1997 and August 31, 2001 were studied. ALND was performed in 164 patients after SLN as part of a training program for surgeons. Patients were contacted by questionnaire or telephone to determine breast cancer relapse; presence of arm lymphedema, arm pain, axillary infection or localized swelling; and tumor recurrence or death.

The researchers found that of the 1,253 women, 894 (71 percent) were node negative (their breast cancer had not spread to the lymph node) by SLN biopsy alone (n=730, or 82 percent) or SLN biopsy and ALND (n=164, or 18 percent). Questionnaires were completed by 776 women (87 percent) and the average follow up time was 2.4 years. Women who underwent ALND reported a significantly higher rate of complications: 34 percent reported arm lymphedema, 38 percent reported arm pain, 24 percent reported localized swelling, and 9 percent reported infection compared with women who underwent SLN alone (6 percent, 14 percent, 7 percent and 3 percent reported these complications, respectively). Only one patient's breast cancer spread to the axillary node after undergoing SLN during follow-up of 685 patients.

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To contact Roy W. Beck, M.D., Ph.D., call Heidi Gillespie at 813/975-8690.

SHORTER EYE PATCHING TIME GIVES SIMILAR RESULTS TO LONGER PATCHING TIMES FOR TREATMENT OF AMBLYOPIA

CHICAGO—Two hours of daily eye patching improves vision just as much as 6 hours of patching in children aged 3 to 7 years old with moderate amblyopia, or "lazy eye", according to an article in the May issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

Amblyopia (poor vision caused by abnormal development of areas of the brain involved in visual processing) is the most common cause of single-eye visual impairment in children and young and middle-aged adults, according to information in the article. Patching of the unaffected eye has been the standard treatment for amblyopia, ranging from as little as 1 or 2 hours of patching a day to continuous patching throughout the day. No previous studies have looked at the optimal amount of time for daily eye patching in the treatment of amblyopia.

Researchers in The Pediatric Eye Disease Investigator Group, led by Roy W. Beck, M.D., Ph.D., of the Jaeb Center for Health Research, Tampa, Fla., compared 2 hours vs. 6 hours of daily eye patching for moderate amblyopia in 189 children between 3 and 7 years old. All the children were also prescribed at least one hour per day of close visual activities (reading, coloring, etc.).

The researchers found that visual improvement for the amblyopic eye improved a similar amount in both groups from baseline to 4 months, with significant visual improvement occurring in 62 percent of patients in each group.

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To contact Joao A. Capao Filipe, M.D., M.Sc., e-mail jacapaofilipe@netcabo.pt

SERIOUS EYE INJURIES CAN OCCUR IN SOCCER PLAYERS AT ALL SKILL LEVELS

CHICAGO—Severe eye injuries can occur in soccer players of all skill levels, according to an article in the May issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

Soccer is the leading cause of sports-related eye injuries in Europe and Israel, according to information in the article. Ophthalmologists have previously helped identify eye injury risks in other sports and develop standards for protective eyewear for hockey, baseball and racquet sports.

Joao A. Capao Filipe, M.D., M.Sc., of University of Porto School of Medicine, S Joao Hospital, Porto, Portugal, and colleagues outlined the type, severity and long-term prognosis for eye injuries in soccer players.

The researchers studied 163 patients with soccer-related eye injuries between April 1, 1992 and March 31, 2000 at the largest university hospital in the northern region of Portugal.

The researchers found that injuries occurred mostly in young men (average age, 23.2 years; age range 9 to 48 years) while practicing indoor (50.9 percent) or outdoor soccer (47.2 percent). Most injuries were the result of a kicked ball (79.1 percent) near the goalpost (60.1 percent). Lesions on the retina or involving the vitreous humor of the eye were present in 42.2 percent of patients who had "normal" vision (20/40 or better) and in 50.0 percent of patents without hyphema (bleeding in the front of the eye).

The researchers conclude: "Indoor and outdoor soccer trauma is an important eye health problem in Europe, and likely in the United States, affecting young athletes independent of age, sex, type of soccer, level of athletic expertise, or player position."

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To contact Thomas F. McNeil, Ph.D., e-mail Thomas.mcneil@psychepi.lu.se

OFFSPRING OF MOTHERS WITH SCHIZOPHRENIA MORE LIKELY TO EXPERIENCE MENTAL DISTURBANCES

CHICAGO—Maternal schizophrenia is associated with a greater likelihood for mental disturbances in their adolescent and young adult children, according to an article in the May issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

According to information in the article, the lifetime risk of developing schizophrenia is approximately 1 percent in the general population, but the risk is 10 percent to 15 percent in children with a parent affected by schizophrenia.

Erland W. Schubert, M.D., and Thomas F. McNeil, Ph.D., of University Hospital, Lund University, Lund, Sweden, followed up 166 adult children in the Swedish High-Risk Project, a study of children of women with schizophrenic, schizoaffective, and affective disorders with no history of psychosis. The children and their environments were studied before they were born, and again during childhood. The researchers report the results of their follow-up of these children at 22 years old.

The researchers found that compared with children whose mothers had no signs of schizophrenia or schizoaffective disorders (n=91), the children of mothers with schizophrenia (n=28) showed a significantly increased frequency of Axis I (clinical disorders like anxiety disorder, depression, schizophrenia) and Axis II disorders (personality disorders such as anti-social disorder or histrionic personality disorder) poor global functioning, high Symptom Checklist- 90 scores (a checklist of psychological symptoms), and a history of mental health care and psychopharmacologic medication use. Children of mothers with affective disorders (n=22) showed high Symptom Checklist- 90 scores, more frequent poor functioning, and receipt of mental health care with a significant increase in Axis I depressive disorders, and no increase in Axis II disorders.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, MAY 12, 2003
To contact Bradley O. Boekeloo, Ph.D., M.S., call Ellen Ternes at 301/405-4627.

PATIENT EDUCATION AND CLINICIAN REMINDERS HELP INCREASE COMMUNICATON ABOUT ALCOHOL

CHICAGO—Priming patients (through using prompt sheets or coaching) and clinician prompting (through reminder stickers on charts and checklists) help increase clinician-patient communication about alcohol, according to an article in the May issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to background information in the article, guidelines recommend that physicians and other health care professionals ask adolescents questions about alcohol use and provide counseling about its risks as part of annual checkups. But the guidelines are not always followed. Priming patients to ask more questions of their health care providers, and prompting clinicians to provide behavioral assessments has been suggested to help doctors and patients communicate more effectively and more often about alcohol-related health issues.

Bradley O. Boekeloo, Ph.D., M.S., of the University of Maryland, College Park, Md., and colleagues investigated whether priming adolescent patients to discuss alcohol with their primary care practitioners and prompting these clinicians to discuss alcohol with their patients increases adolescent-provider communication about alcohol.

The researchers studied patients aged 12 to 17 years old who had a regular checkup with their primary care clinician at one of five managed care group practices in Washington, D.C. Of the 892 patients studied, 444 (50 percent) were assigned to the priming/prompting intervention. Most patients (80 percent) were African American, 55 percent were male, and 17 percent reported drinking alcohol.

The adolescents were divided into three groups: group 1 received no special priming, group 2 was primed before their visits, and adolescents in group 3 were primed and their clinicians were prompted. Data was collected through exit surveys completed by the adolescents after their checkups, researcher observation and audiotapes of sample visits.

The researchers found that more adolescents in group 3 (96 percent) than group 1 (87 percent) reported that their clinician talked about alcohol. More adolescents in group 3 (18 percent) than group 1 (10 percent) reported asking about alcohol. The average number of minutes adolescents were with their health care professionals without their parents being present was greater for group 3 (average time= 10.8 minutes) than group 1 (average time = 8.8 minutes).

The researchers write, "Data from adolescent self-reports and researcher observations revealed that priming adolescents to talk with their provider about alcohol and prompting providers to talk with their adolescent patient about alcohol increased 2-way adolescent-provider communication about alcohol and may have increased communication about the adolescent's personal alcohol-related behaviors."