EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 14, 2004
To contact Eunyoung Cho, Sc.D., call Melanie Franco at 617/534-1605.

FRUIT MAY HELP PREVENT VISION LOSS IN OLDER PEOPLE

Eating fruit may help protect against the development of age-related maculopathy (ARM), an eye disease that can cause blindness, according to an article in the June issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

According to information in the article, ARM is the leading cause of vision loss among people 65 and older. Because there are no effective treatments for ARM, prevention of this eye disease is important. Antioxidant vitamin and mineral supplementation has been found to help protect against ARM. In a recent study, supplementation with high-doses of vitamins C and E, beta carotene and zinc delayed the progression of ARM.

Eunyoung Cho, Sc.D., of Brigham and Women's Hospital, Boston, and colleagues examined the effect of antioxidant vitamins and carotenoids (compounds responsible for the red, yellow and orange pigments found in some fruits and vegetables) as well as fruits and vegetables on the development of ARM among 77,562 women and 40,866 men. The women were part of the Nurses' Health Study, and the men were participants in the Health Professionals Follow-up Study. Participants were at least 50 years old at the beginning of the study with no diagnosis of ARM. Women were followed for up to 18 years, and men were followed for up to 12 years.

Women completed food consumption questionnaires up to five times over the follow-up period (in 1980, 1984, 1986, 1990 and 1994), and men answered similar questionnaires up to three times over the follow-up period (in 1986, 1990, and 1994). Participants also reported their vitamin and supplement use once every two years.

Over the follow-up period, the researchers documented a total of 464 (329 women and 135 men) new cases of early stage ARM, and 316 (217 women and 99 men) cases of neovascular ARM (a more severe type of ARM).

The researchers found that fruit consumption was inversely associated with risk of neovascular ARM, and participants who ate three or more servings per day of fruit had a 36 percent lower risk of ARM compared to participants who reported eating less than 1.5 servings per day. These findings were similar for men and women.

The researchers also found that "None of the vegetable items appeared to be strongly related to either early or neovascular ARM risks, except that carrot intake had a weak, nonsignificant inverse association with the neovascular form."

"None of the antioxidant vitamins and carotenoids was strongly related to either early or neovascular ARM risk, although many of them, including total carotenoids, had a suggestive inverse association with neovascular ARM risk," the researchers write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 14, 2004
To contact corresponding author Paul P. Lee, M.D., J.D., call Bob Shepard at 205/934-8934.

CHOLESTEROL-LOWERING MEDICATIONS MAY REDUCE RISK OF GLAUCOMA

CHICAGO—Long-term use of statins, medications commonly prescribed to lower cholesterol, may be associated with a reduced risk of glaucoma among patients with cardiovascular diseases and high cholesterol, according to an article in the June issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

According to information in the article, the use of statins has been associated with a lowered risk of developing age-related macular degeneration, a disorder of the retina that can cause gradual vision loss and is the leading cause of blindness among European-descended people older than 65 years.

Gerald McGwin, Jr., M.S., Ph.D., of the University of Alabama at Birmingham, and colleagues investigated whether oral statins or other cholesterol-lowering medications are associated with any change in the risk of glaucoma, an eye disease characterized by increased pressure in the eye.

The researchers used data from the medical records of 667 men aged 50 or older with a new diagnosis of glaucoma between January 1, 1997 and December 31, 2001. The researchers compared these men to 6,667 control patients (men older than 50 without a diagnosis of glaucoma). Prescription records were searched for statin use as well as additional medications to lower cholesterol for control participants and patients with glaucoma.

The researchers found that patients who used statins for 24 months or more had a significant reduction in risk for glaucoma. The use of nonstatin cholesterol-lowering medications was also associated with a significantly reduced risk for glaucoma.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 14, 2004
To contact David Juurlink, M.D., Ph.D., call Julie Argles at 416/480-4780. To contact editorialist Eve K. Moscicki, Sc.D., M.P.H., call the National Institute of Mental Health Press Office at 301/443-4536.

SUICIDE AMONG ELDERLY PERSONS ASSOCIATED WITH ILLNESS

CHICAGO—Many common illnesses are independently associated with an increased risk of suicide in elderly people, according to an article in the June 14 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, suicide is the 11th leading cause of death in the United States and is especially common among the elderly. Elderly people in many countries kill themselves at a rate higher than any other segment of the population. Medical illnesses may predispose to suicide, but few studies have examined the association between suicide and specific illnesses, the article states.

David N. Juurlink, M.D., Ph.D., of Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, and colleagues examined the relationship between treatment for several illnesses and the risk of suicide in elderly patients.

The researchers examined the prescription records of all Ontario residents 66 years and older who committed suicide between January 1, 1992 and December 31, 2000. For each resident who committed suicide, the researchers also looked at the prescription records of four living controls matched for age, sex, residential area, and income to determine the presence or absence of 17 illnesses potentially related to suicide.

Among the 1,329 elderly persons who committed suicide (1,012 men; 317 women), the most common methods involved firearms (28 percent), hanging (24 percent), and self-poisoning (21 percent). Depression, bipolar disorder (manic-depressive illness) and severe pain were associated with the largest increases in suicide risk. However, several other chronic illnesses including seizure disorder, congestive heart failure, and chronic lung disease, were also associated with an increased risk for suicide.

The researchers also found that treatment for multiple illnesses was strongly related to an increased risk of suicide, and that most of the patients who committed suicide visited a physician in the month before death, about half of them during the preceding week.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 14, 2004
To contact corresponding author Elizabeth A. Calhoun, Ph.D., call Elizabeth Crown at 312/503-8928.

PROSTATITIS ASSOCIATED WITH HIGH MEDICAL COSTS

CHICAGO—Patients with chronic prostatitis associated with chronic pelvic pain have substantial health care costs and have reduced quality of life, according to an article in the June 14 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, chronic prostatitis/chronic pelvic pain syndrome (CPPS) is a common disorder characterized by pelvic pain and lower urinary tract symptoms. Between 1990 and 1994, CPPS accounted for almost 2 million outpatient visits per year in the United States. Tests to diagnose CPPS are unreliable and the effectiveness of the most commonly prescribed treatments are not supported by existing evidence, the article states, and patients with CPPS report symptoms associated with depression and hypochondriasis.

Elizabeth A. Calhoun, Ph.D., from Northwestern University, Chicago, and colleagues examined the direct and indirect costs associated with chronic prostatitis among 167 men (average age, 44 years, 78 percent white) enrolled in the Chronic Prostatitis Cohort (CPC). Participants had pain in their pelvic region for at least three months within the last six months before joining the study, and responded to a questionnaire on use of health care resources. This information was used to calculate direct medical costs (based on hospital accounting data), and indirect costs (based on modified labor force, employment, and earnings data from the U.S. Census Bureau).

The researchers found that 82 percent of the participants accrued some costs over the three months prior to enrollment in the CPC. The average total costs (direct and indirect) for the three months were $1,099 per person, with an expected annual total cost per person of $4,397. Procedures and tests (average, $761) were responsible for the largest portion of direct costs, followed by health care visits (average, $325) and medication (average, $282). Of the men, 26 percent reported work loss valued at an average of $551.

Forty-nine percent of the participants had a procedure during the three months, with an average of six procedures during this time period. The most common procedures were urinalysis, urine culture and prostate massage. Of the participants, 64 percent saw a physician during these months, with an average of 5 visits per person (52 percent visited a urologist; 20 percent visited a primary care physician; 7 percent were seen in an urgent care or emergency department setting; and 6 percent saw an acupuncturist).

"We demonstrated that the management of prostatitis is associated with substantial direct and indirect costs," the authors write. "We believe that our estimate of cost is conservative, since we did not quantify the loss of work productivity reported by 79 percent of the study participants and did not include hospitalization costs."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 14, 2004
To contact corresponding author Edward H. Phillips, M.D., call Sandy Van at 1-800/ 396-1002.

POST-SURGICAL PAIN MAY BE AGE RELATED

CHICAGO—Pain after surgery to repair hernia was less intense for younger patients undergoing the procedure, according to an article in the June issue of the Archives of Surgery, one of the JAMA/Archives journals.

Hernia is a general term used to describe the protrusion of an organ through the muscle or structure that holds it in place. Often, hernia refers to the protrusion of the intestines through a muscle in the groin area.

Fumihiko Fujita, M.D., from Cedars-Sinai Medical Center, Los Angeles, and colleagues collected information on pain from 253 patients (239 men, average age 59 years) undergoing either laparoscopic hernia repair (n=110) or open, non-laparoscopic hernia repair (n=143). Pain information was collected from patients one day, and one week after their surgeries. All participants were seen by a single surgical group between May 1998 and April 2003. Laparoscopic patients were significantly younger (52 vs. 63.8 years).

The researchers found that satisfaction was high for both procedures, and the laparoscopic procedure was superior only in that patients were able to return to work sooner. Analysis showed a significant inverse association between age and amount of pain on the first day after surgery, regardless of the type of surgery used to repair the hernia.