EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JANUARY 12, 2004
To contact Cris A. Slentz, Ph.D., call Richard Merritt at 919/684-4148.

EVEN MODERATE AMOUNTS OF EXERCISE CAN PREVENT WEIGHT GAIN

CHICAGO—Moderate amounts of exercise, such as walking 12 miles per week, may help prevent weight gain, and can promote weight loss in non-dieting individuals, according to an article in the January 12 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

Fifty-five percent of Americans are overweight or obese, according to the article. From 1991 to 1998, the prevalence of obesity increased by almost 50 percent. Obesity is associated with a higher risk for several health problems, including heart disease and diabetes mellitus. It is widely believed that diet, combined with physical activity plays an important role in weight management, but the amount of activity needed to prevent weight gain is unknown.

Cris A. Slentz, Ph.D., from Duke University Medical Center, Durham, N.C., and colleagues investigated the effects of different amounts and intensities of exercise on weight.

The researchers conducted a randomized, controlled trial in which 182 sedentary overweight men and women (aged 40-65 years) were assigned to either: high amount/vigorous intensity exercise (equivalent to jogging approximately 20 miles per week at 65 percent to 80 percent peak oxygen consumption); low amount/vigorous intensity exercise (equivalent to 12 miles of jogging per week at 65 percent to 80 percent peak oxygen consumption); or low amount/moderate intensity exercise (equivalent to 12 miles of walking per week at 40 percent to 55 percent peak oxygen consumption). A fourth group (the control group) did not exercise. The study lasted eight months and participants were asked not to change their diets during this time. Body weight and waist circumference were measured. Of the 182 participants enrolled, 120 completed the study.

The researchers found that there was a clear relationship between the amount of physical activity and amount of weight loss, with the most weight loss seen in the high amount/vigorous intensity group, and the least in the low amount/moderate intensity group. The control group gained weight over the study period. Compared with the control group, all exercise groups significantly decreased abdominal waist and hip circumference measurements.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JANUARY 12, 2004
To contact Maurice M. Ohayon, M.D., D.Sc., Ph.D., call Michelle Brandt at 650/723-0272.

MORNING HEADACHES ASSOCIATED WITH DEPRESSION, ANXIETY DISORDERS

CHICAGO—Morning headaches affect about one person in 13 in the general population and are associated with depression and anxiety disorders, according to an article in the January 12 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to the article, waking up with a headache is traditionally associated with sleep disorders. Studies have reported a high association between morning headache and obstructive sleep apnea syndrome, and snoring. The prevalence of morning headache in the general population is not known, although according to a Swedish study, 5 percent of the population often experiences morning headache.

Maurice M. Ohayon, M.D., D.Sc., Ph.D., of Stanford University School of Medicine, Palo Alto, Calif., investigated the prevalence of chronic morning headaches (CMH) in the general population, and their relationship to sociodemographic characteristics, controlled substance use, and clinical, sleep and mental disorders.

A telephone questionnaire was used to survey 18,980 people (15 years or older) representative of the populations of the United Kingdom, Germany, Italy, Portugal, and Spain. The questionnaire included questions about morning headaches, clinical disorders, use of psychoactive substances, and sleep and mental disorders.

Overall, the prevalence of CMH was 7.6 percent (n=1,442). CMH were reported to occur "daily" by 1.3 percent of the individuals surveyed; "often" by 4.4 percent of the survey sample; and "sometimes" by 1.9 percent of the sample. Rates were higher in women than in men (8.4 percent vs. 6.7 percent) and in people aged between 45 and 64 years (about 9 percent). The most significant factors associated with CMH were anxiety and depressive disorders.

Dr. Ohayon also found that CMH was significantly associated with sleep-related breathing disorders, hypertension, musculoskeletal diseases, use of anxiolytic medication and heavy alcohol consumption.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JANUARY 12, 2004
To contact Lee A. Fleisher, M.D., call Jen Miller at 215/349-5657.

RISKS ASSOCIATED WITH OUTPATIENT SURGERY VARY WITH PATIENT CHARACTERISTICS, TYPE OF SURGICAL FACILITY

CHICAGO—The likelihood of an elderly patient being admitted to a hospital within seven days, or dying shortly after undergoing surgery in an outpatient setting depends on health-related characteristics of the patient, and where the surgery was performed, according to an article in the January issue of the Archives of Surgery, one of the JAMA/Archives journals.

According to the article, it is estimated that approximately 60 percent to 70 percent of all surgical procedures are now performed in an outpatient setting (for example, a physician's office or specialized surgery center), and more and more high-risk patients, including the elderly, are having outpatient surgeries.

Lee A. Fleisher, M.D., who conducted his research while at The Johns Hopkins University, Baltimore, and colleagues examined the risk associated with 16 different surgical procedures among elderly (older than 65 years) Medicare beneficiaries from 1994 through 1999. Dr. Fleisher is now at the University of Pennsylvania School of Medicine, Philadelphia. (The procedures included cataract removal, prostate resection, hernia repair, laparoscopic gall bladder removal, dilation and curettage, vaginal hysterectomy, simple and modified mastectomy, hemorrhoidectomy, arteriovenous graft placement, knee arthroscopy, rotator cuff surgery).

The researchers studied 564,267 outpatient surgical procedures of which 360,780 were performed at a hospital-based outpatient center, 175,288 were performed at freestanding ambulatory surgery centers (ASCs), and 28,199 were performed in a physician's office.

There were no deaths on the day of surgery at a physician's office, four deaths the day of surgery at an ASC (2.3 per 100,000 procedures), and 9 deaths on the day of surgery at an outpatient hospital (2.5 per 100,000 procedures). The seven-day death rate was 35 per 100,000 outpatient procedures at a physician's office; 25 per 100,000 procedures at an ASC; and 50 per 100,000 procedures at a hospital-based outpatient center.

The researchers also found that the rate of admission to an inpatient hospital after outpatient surgery varied by surgical setting: admission to an inpatient hospital within seven days of outpatient surgery was 9.08 per 1,000 outpatient procedures at a physician's office, 8.41 per 1,000 procedures at an ASC, and 21 per 1,000 procedures at a hospital-based outpatient center.

More advanced age, prior inpatient hospitalization within the past six months, and invasiveness of the surgery performed were indicators of an increased risk of hospital admission or death within seven days of outpatient surgery.

The authors write that the study demonstrates that "patient outcomes are a function of patient characteristics independent of the surgical procedure, confirming the current perception of risk as a multivariate phenomenon," the researchers write. "The accelerated pace at which more complex procedures are being performed in locations increasingly removed from sophisticated support facilities requires that this effort be structured to permit appropriate assessment of these trends."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, JANUARY 12, 2004
To contact corresponding author Wolfgang Radner, M.D., e-mail wolfgang.radner{at}univie.ac.at.

INFORMED CONSENT DOES NOT SEEM TO INFLUENCE DECISION-MAKING PROCESS FOR CATARACT SURGERY

CHICAGO—Informing patients of the risks of cataract surgery as part of the informed consent procedure one day before surgery does not seem to influence patients' decisions to have the procedure, according to an article in the January issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

Cataract surgery is the most frequently performed eye surgery and is the cause for one third of all lawsuits against ophthalmologists, according to the article. Cataracts occur when the lens of the eye becomes cloudy and opaque, which can compromise vision. During cataract surgery, the clouded lens is removed, and an artificial lens is placed. Informed consent is a process by which the patient is informed of what will happen during surgery, what the possible risks are, and what he or she can expect during recovery. Cataract surgery has a very low risk of complications, but the number of malpractice claims associated with cataract surgery is rising. For a malpractice claim to be initiated, negligence, injury, and the proximate cause (i.e., the procedure caused the injury) need to be evident, but because malpractice is often hard to prove, inadequate or lack of informed consent is used as a secondary cause in more than 90 percent of all ophthalmologic malpractice cases. It has been well documented in several clinical studies that very little of the information given during the informed consent procedure can be recalled correctly by the patients even one day after surgery, the article states.

Christopher G. Kiss, M.D., of the University of Vienna, Austria, and colleagues studied the decision-making process by patients on the day before cataract surgery and evaluated the extent to which the informed consent process influenced patients' decisions to undergo surgery.

The researchers enrolled 70 patients (average age 70 years) about to undergo cataract surgery. On the day before their surgeries, the 70 patients underwent a standardized informed consent procedure. They were also invited to answer 15 questions developed by clinical psychologists, lawyers and ophthalmologists.

The results of the survey indicated that 28 (40 percent) of the 70 participants arrived for surgery without any information; 16 (23 percent) believed that there were surgical procedures without any risks; and 53 (76 percent) believed that there were no risks for their cataract surgery. Thirty-one patients (44 percent) preferred that their physician make the decision for surgery, while 16 (26 percent) wanted to make the decision together with their ophthalmologist.

The risk of a complication that could compromise sight did not influence 54 patients' (77 percent) decisions, and 55 patients (78 percent) said the informed consent process did not influence their decision. Fifteen patients (22 percent) said that the informed consent process helped confirm their decision to undergo cataract surgery.