CHICAGO—Two studies examining the outcomes for children of different races/ethnicities being treated for acute lymphoblastic leukemia (ALL) show contrasting results, according to the articles in the October 15 issue of The Journal of the American Medical Association (JAMA).

In the first article, Ching-Hon Pui, M.D., of St. Jude Children's Research Hospital, Memphis, Tenn., and colleagues analyzed the results of successive clinical trials during the 1990s at a single institution to determine if the benefits of improved therapy extend equally to black and white children with ALL.

According to background information in the article, in ALL, the most common childhood cancer, black children treated from 1960 to 1990 consistently had a worse treatment outcome than did white children treated during the same period.

This study included 412 children and adolescents (68 black, 338 white, and 6 other race) with newly diagnosed ALL who were treated at St. Jude Children's Research Hospital, in Memphis, Tenn., a pediatric cancer center. Patients were enrolled from December 1991 to July 1998 in successive therapy studies regardless of race, ethnicity, or ability to pay and received risk-directed therapy according to stringent criteria. All patients received the same intensive remission-induction therapy followed by 120 weeks of risk-assigned postremission therapy.

The researchers found that "black children with ALL can expect the same high rate of cure now being attained in white children, if they have equal access to contemporary effective antileukemic treatment delivered in a single pediatric cancer center," they write. "Five-year event-free survival rates for the 2 cohorts were virtually identical: 80.7 percent vs. 79.4 percent at 5 years and 74.8 percent vs. 73.6 percent at 10 years for black and white patients, respectively. With 10-year overall survival rates of 86.2 percent and 80.3 percent, it appears that approximately 80 percent of both black and white patients will be cured, a superior end result compared with the 75 percent cure rate in the 1980s."

CHICAGO—Patients with Alzheimer disease were less depressed and had better physical health when they exercised and their caregiver received behavioral management techniques, according to an article in the October 15 issue of The Journal of the American Medical Association (JAMA).

Linda Teri, Ph.D., of the University of Washington, Seattle, and colleagues conducted a study to determine whether a home-based exercise program for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems would help decrease the frailty and behavioral impairment that are often prevalent and that can lead to increased functional disability and institutionalization.

The study was a randomized controlled trial that included 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease. The trial was conducted between June 1994 and April 1999.

Patient-caregiver pairs were randomly assigned to the combined exercise and caregiver training program, Reducing Disability in Alzheimer Disease (RDAD), or to routine medical care (RMC). The RDAD program was conducted in the patients' home over 3 months.

At three months, in comparison with the routine care patients, more patients in the RDAD group exercised at least 60 min/wk (nearly 3 times more likely) and had fewer days of restricted activity (more than 3 times more likely). Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group. Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores. At 2 years, the RDAD patients continued to have better physical role functioning scores than the RMC patients and showed a trend for less institutionalization due to behavioral disturbance. For patients with higher depression scores at baseline, those in the RDAD group improved significantly more at three months on the Hamilton Depression Rating Scale and maintained that improvement at 24 months.

"This study demonstrated that an integrated treatment program designed to train dementia patients and their caregivers in exercise and behavioral management techniques was successfully implemented in a community setting. Caregivers were able to learn how to encourage and supervise exercise participation, and patients participating in this program achieved increased levels of physical activity, decreased rates of depression, and improved physical health and function," the authors write.

CHICAGO—Relief of poverty appears to be associated with improvement of some psychiatric disorders in children, but not improvement in anxiety or depression, according to an article in the October 15 issue of The Journal of the American Medical Association (JAMA).

According to background information in the article, social causation (adversity and stress) vs. social selection (downward mobility from familial liability to mental illness) are competing theories about the origins of mental illness.

E. Jane Costello, Ph.D., of Duke University Medical School, Durham, N.C., and colleagues examined the mental health of children whose families moved out of poverty, compared with children whose families remained poor despite an intervention and with those who were never poor. The authors speculated that if family poverty caused specific emotional and behavioral problems in children, then after poverty was removed, these psychiatric symptoms should improve or disappear.

The study included a representative population sample of 1,420 rural children aged 9 to 13 years who were given annual psychiatric assessments for 8 years (1993-2000). One-quarter of the sample were American Indian, and the remaining were predominantly white. Halfway through the study, a casino opening on the Indian reservation gave every American Indian an income supplement that increased annually. With this increase 14 percent of study families moved out of poverty (i.e., family income level above the federal poverty line), while 53 percent remained poor, and 32 percent were never poor. The psychiatric symptoms in the never-poor, persistently poor, and ex-poor children were compared for the 4 years before and after the casino opened.

The researchers found that:

• Moving out of poverty was associated with a decrease in frequency of psychiatric symptoms over the ensuing 4 years; by the fourth year the symptom level was the same in children who moved out of poverty as in children who were never poor.
• Adding to the income of never-poor families had no effect on frequency of psychiatric symptoms.
• The effect of poverty was strongest for behavioral symptoms (such as conduct and oppositional disorder). Little effect of moving out of poverty on emotional symptoms (such as anxiety and depression) was observed.
• The effect of relieving poverty was mediated by 1 factor: level of parental supervision.
• The same models run using the non-Indian participants showed the same results.

CHICAGO—Individuals with exceptional longevity and their children have significantly larger high-density lipoprotein (HDL) and low-density lipoprotein (LDL) particles, according to a new study published in the October 15 issue of The Journal of the American Medical Association (JAMA). Lipoproteins are composed of a simple protein and a fat component (cholesterol) that carry fats, particularly cholesterol, in the blood.

"Individuals with exceptional longevity have been generally spared from major age-related diseases that are responsible for most deaths in elderly persons, such as cardiovascular disease (CVD), diabetes mellitus, Alzheimer disease, and cancer," the authors provide as background information. "Various studies suggest that genetic determinants of exceptional longevity are highly heritable. …Identification of biological markers and genes that are conducive to exceptional longevity may provide insights into mechanisms that protect from a host of common diseases and/or slow the biological processes of aging."

Nir Barzilai, M.D., from the Albert Einstein College of Medicine, New York, and colleagues analyzed data from long-lived Ashkenazi Jewish men and women and their children to see if they could identify specific biologic and genetic factors that are associated with human longevity.

The researchers recruited 213 Ashkenazi Jewish participants with exceptional longevity (an average age of 98 years; 48 percent were over 100 years) and their children (n = 216) with an average age of about 68 years. The participants were recruited from 1998 to 2002. The researchers used two control groups for this study. An age-matched control group of Ashkenazi Jews (n = 258) and participants from the Framingham Offspring Study (n = 589). The study participants were evaluated by medical histories, height, weight, and physical examinations. Blood samples were taken for assessment of lipids and lipoprotein subclass levels and measurement of particle sizes by proton nuclear magnetic resonance. Samples were also genotyped looking for variations in the cholesteryl ester transfer protein (CETP) gene, which is involved in the regulation of lipoprotein and its particle sizes.

"This study demonstrates to our knowledge the first time that families with exceptional longevity have markedly larger particle sizes of HDL and LDL, which are largely independent of the absolute levels of lipoproteins and apolipoproteins [the protein components of lipoproteins]. This particular phenotype [the entire physical, biochemical, and physiological makeup as determined both genetically and environmentally] is associated with a lower prevalence of hypertension and CVD and the metabolic syndrome in their offspring compared with appropriately age-matched control groups, supporting a functional role for lipoproteins in promoting survival to very old age," the authors report.

SIMPLE EXERCISE PROGRAM IMPROVES PHYSICAL HEALTH AND DEPRESSION FOR ALZHEIMER PATIENTS