EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 14, 2003
To contact Diane E. Meier, M.D., call Debra Kaplan at 212/659-9045.

LIGHT TO PATIENTS WHO REQUEST AND RECEIVE PHYSICIAN-ASSISTED DEATH ARE SERIOUSLY ILL AND HAVE A HIGH BURDEN OF PHYSICAL PAIN

CHICAGO—Patients who request and receive physician-assistance in dying are often seriously ill with little time to live and experience a high degree of physical pain and suffering, according to an article in the July 14 issue of The Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, national surveys suggest that 1 in 5 physicians in the United States have received at least one request to assist a terminally ill patient to die, and approximately 3 percent to 18 percent reportedly agree to these requests even though the practice is illegal in all states but Oregon.

Diane E. Meier, M.D., of Mount Sinai School of Medicine, New York, and colleagues analyzed data from a national survey on physician-assisted suicide.

Physicians involved in caring for seriously ill patients were asked to describe the characteristics associated with their most recent patient to ask for physician-assisted dying who they refused to assist, and characteristics of their last patient to ask for physician-assisted death whose request was honored.

The researchers found that of 1,902 respondents to the survey, 379 described 415 instances of their most recent request for physician-assisted death refused and 80 instances of their most recent request for assisted dying honored. The physicians described these patients as seriously ill, near death and with a significant burden of pain and discomfort. Almost half were described as depressed at the time of their request. The majority of patients asking for assistance in dying made the request themselves, along with family.

The researchers also found that physicians were almost two and one half times more likely to honor the requests of patients who were in severe pain and more than 6 times as likely if the patients were experiencing discomfort. Physicians were more than 4 times more likely to honor requests if the patient had a life expectancy of less than 1 month, and 20 percent more likely to grant the request if they believed the patient was not depressed at the time of request.

"The major finding of this analysis is that patients receiving a physician's assistance in hastening their death are making specific requests, have a substantial burden of physical pain and distress, and are expected to die of their illness within a short time," the researchers write. "Requests for prescriptions are made by patients who appear to have time and capacity to deliberate before making their decision to ask for a hastened death. For their part, physicians appear to decide to honor their patients' requests for a lethal prescription among highly symptomatic individuals, a finding also reported by other investigators," write the authors.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 14, 2003
To contact Roy W. Beck, M.D., Ph.D., call Robin Gal at 210/764-0885.

STUDY DOCUMENTS RISK OF DEVELOPING MULTIPLE SCLEROSIS 10 YEARS AFTER HAVING OPTIC NEURITIS

CHICAGO—Among patients who have had an episode of acute optic neuritis (inflammation of the optic nerve), approximately 40 percent will develop multiple sclerosis in 10 years and the risk is significantly higher if a brain lesion is detected by magnetic resonance imaging (MRI), according to an article in the July issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

Optic neuritis is a common initial manifestation of multiple sclerosis, according to information in the article. Opitc neuritis usually manifests as blindness in one eye and eye pain, and women are more commonly affected than men. In patients with optic neuritis, the presence of brain lesions as detected by MRI increases the probability that more symptoms of multiple sclerosis will develop.

Roy W. Beck, M.D., Ph.D., of the Optic Neuritis Study Group Coordinating Center at the Jaeb Center for Health Research, Tampa, Fla., and colleagues previously reported the results of the Optic Neuritis Treatment Trial that calculated the 5-year risk of developing multiple sclerosis after an initial episode of optic neuritis in 388 patients. The patients had all experienced an episode of optic neuritis between July 1, 1988 and June 30, 1991 and were not diagnosed with multiple sclerosis at the beginning of the study. The current study reports the 10-year risk of developing multiple sclerosis based on continued follow-up of patients enrolled in the Optic Neuritis Treatment Trial.

The researchers found that the 10-year risk of developing multiple sclerosis after experiencing acute optic neuritis was 38 percent. Patients who had one or more lesions on their MRIs at the beginning of the study (n=160) had a 56 percent risk, and those with no lesions (n=191) had a 22 percent risk.

"The most potent predictor of multiple sclerosis in our study was the presence of white matter lesions on the baseline MRI scan of the brain," write the researchers. "The presence of 1 such lesion at least 3 millimeters in diameter more than doubled the 10-year risk of multiple sclerosis (from 22 percent to 56 percent). However, the presence of 1 or more lesions did not signify that the patient was destined to develop multiple sclerosis."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 14, 2003
To contact Brian M. DeBroff, call Karen Peart at 203/432-1326.

EYE BLACK GREASE, BUT NOT ANTIGLARE STICKERS, REDUCES GLARE AND IMPROVES VISUAL CONTRAST

CHICAGO—Eye black grease, a product used by athletes that is smudged under the eyes to reduce glare, is more effective at reducing glare and improving contrast than antiglare stickers placed under the eyes, according to an article in the July issue of The Archives of Ophthalmology, one of the JAMA/Archives journals.

According to information in the article, glare from sunlight or stadium lighting can impair an athlete's ability to see detail and the sensitivity to contrast. Previous studies have shown that the higher an athlete's sensitivity to contrast, the better he or she can see an object as its speed increases. Eye black grease applied to the cheekbones is a product athletes have used to reduce glare when light is reflected into the eyes off the cheekbones. Dark colored antiglare stickers applied to the cheekbones are also commonly used by athletes to reduce glare.

Brian M. DeBroff, M.D., and Patricia J. Pahk, M.D., of Yale University School of Medicine, New Haven, Conn., investigated the effect of these glare-reducing products on contrast sensitivity.

The researchers tested 46 students (ages 18 to 30 years old; 92 eyes) for contrast sensitivity with and without anti-glare products. Contrast sensitivity was measured in all participants without any antiglare products. Participants were then randomized to three groups: eye black grease (n=16), antiglare stickers (n=14), or petroleum jelly placebo (n=16). The researchers used natural sunlight as their light source.

The researchers found that there was a roughly one level of sensitivity improvement between no products vs. eye black grease, according to the Pelli-Robson chart, a tool used to measure contrast sensitivity. Antiglare stickers and petroleum jelly did not significantly improve contrast sensitivity.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 14, 2003
To contact Kari Laine, M.D., Ph.D., e-mail karlai{at}utu.fi

BABIES EXPOSED TO SSRIS IN LATE PREGNANCY MAY HAVE NEUROLOGICAL SYMPTOMS AFTER BIRTH

CHICAGO—Infants whose mothers took selective serotonin reuptake inhibitors (SSRIs, drugs used to treat some psychiatric disorders) during late pregnancy are at an increased risk for having neurologic adverse effects linked to the drugs during the first weeks of life, according to an article in the July issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

Mood and anxiety disorders such as depression, panic disorder and obsessive-compulsive disorder are common in women during child bearing years, according to the article. SSRIs, which increase the availability of the neurotransmitter serotonin, are often used in the treatment of mental disorders in pregnant women. Previous studies suggest that taking SSRIs during the third trimester may lead to neurologic symptoms in newborns, including irritability, constant crying, eating and sleeping difficulties and even convulsions.

Kari Laine, M.D., Ph.D., of the University of Turku, Finland, and colleagues studied the effects of SSRIs on newborns exposed to the drugs during the third trimester of pregnancy.

The researchers enrolled 40 pregnant women in their study between January 1, 1997 and August 31, 2000. Twenty of the women were taking SSRIs during pregnancy and breastfeeding. The other 20 women were not taking any psychoactive medications. The newborns were assessed for serotonin-related neurologic symptoms including muscle spasms, restlessness, tremor, shivering, rigidity and poor coordination on the first four days of life and again at two weeks and two months after delivery. Infants also underwent brain ultrasound and magnetic resonance imaging (MRI) 38 to 42 weeks after conception and again at the age of 2 months.

The researchers found that there were no major differences in basic vital signs (blood pressure, heart rate, body temperature) in the two groups of infants during the first 2 months of life. There was a significant 4-fold difference in serotonin-related symptoms during the first 4 days of life between the SSRI group and the control group. The most common symptoms in newborns included tremor, restlessness and rigidity. The researchers also found a significant reduction in serotonin-related symptoms from 1 to 4 days to 2 weeks in the SSRI group, and no significant difference in symptoms was detectable between the two groups at 2 weeks.

"In conclusion, we report increased risk for central nervous system serotonergic adverse effects during the first days of life in newborns of mothers taking the SSRIs citalopram or fluxetine during the third trimester of pregnancy," write the authors.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 14, 2003
To contact Susan F. Tapert, Ph.D., call Sue Pondrom at 619/543-6163.

TEENAGERS WITH ALCOHOL ABUSE DISORDER HAVE STRONGER BRAIN RESPONSES TO ADVERTISEMENTS FOR ALCOHOLIC BEVERAGES THAN NONDRINKERS

CHICAGO—Adolescents with alcohol use disorder (AUD) have stronger reactions to alcohol-related images and advertisements than non-drinking teens, according to an article in the July issue of The Archives of General Psychiatry, one of the JAMA/Archives journals.

According to information in the article, cue reactivity (having a measurable reaction to a stimulus, such as a picture or word) has been used to measure craving in adults with AUD. Adults with AUD express physiological changes such as increased heart rate or salivation when exposed to alcohol-related pictures, words and tactile cues, and have trouble shifting attention away from alcohol-related stimuli.

Susan F. Tapert, Ph.D., of Veterans Affairs San Diego Healthcare System, San Diego, and colleagues used functional MRI (fMRI, where changes in brain activity are mapped while the patient is exposed to various stimuli) to look at changes in brain activity in adolescents as they were shown advertisements for alcoholic and non-alcoholic beverages. The researchers recruited high school students aged 14 to 17 years old with a history of AUD (n=15), and adolescents with no history of AUD (n=15).

The researchers found that teens with AUD showed substantially greater brain activity in response to advertisements for alcoholic beverage than teens without AUD, mostly in the left anterior, limbic, and visual system areas of the brain. The degree of brain response to the alcohol-related advertisements was highest in teens who consumed more drinks per month and reported greater cravings for alcohol.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JULY 14, 2003
To contact James D. Sargent, M.D., call Andy Nordhoff 603/650-1492.

STUDY EXAMINES FACTORS RELATED TO ADOLESCENTS' VIEWING OF SMOKING IN MOVIES

CHICAGO—Availability of home movie channels, the number of movie videos watched per week and lack of parental restriction on R-rated movies are associated with adolescents having increased exposure to smoking depicted in movies, according to an article in the July issue of The Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

According to information in the article, smoking by characters in movies sends a powerful message to adolescents. Film directors use smoking to project toughness, rebelliousness and sexiness in their characters. Evidence suggests that exposure to smoking in movies may influence adolescent smoking, and adolescents whose favorite movie star smokes are more likely to smoke themselves.

James D. Sargent, M.D., of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues measured adolescents' exposure to depictions of smoking in movies and examined factors that could reduce exposure.

The researchers counted occurrences of smoking in 601 popular movies in 1999. They asked 4,910 northern New England junior high school students to report which films they had seen from a sample of 50 randomly generated movie titles in order to estimate their exposure to the entire sample of 610 films.

The researchers found that the students had seen an average of 30 percent of the total movie sample, and were exposed to an average of 1,160 occurrences of smoking. The researchers determined that exposure to movie smoking increased about 10 percent for each additional movie channel in the home and for every 2 videos watched per week. Exposure increased by 30 percent for those going to the movie theatre more than once per month compared with those who did not go at all. There was also no association between parenting style (R-rated movie and television restrictive vs. no media restrictions) and exposure to movie smoking.

The researchers also found that parental restriction on viewing R-rated movies reduced exposure to movie smoking by 50 percent.