EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 9, 2004
To contact Nananda F. Col, M.D., M.P.P., M.P.H., call Nicole Gustin at 401/444-7299.

COMPUTER MODEL SUGGESTS THAT SHORT-TERM HORMONE THERAPY SHORTENS LIFE EXPECTANCY BUT INCREASES QUALITY OF LIFE FOR WOMEN WITH MENOPAUSAL SYMPTOMS

CHICAGO—A computer-based simulation model suggests that short-term hormone therapy (HT) is associated with increases in quality of life for women with menopausal symptoms, but may shorten life expectancy, according to an article in the August 9/23 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, decisions concerning menopausal hormone therapy (HT) are difficult due to the complexity of balancing the risks and benefits of this treatment. HT is an effective treatment for menopausal symptoms and decreases the risks of osteoporosis and colorectal cancer, but it may also increase the risk of coronary heart disease, stroke, blood clots and breast cancer.

Nananda F. Col, M.D., M.P.P., M.P.H., of Rhode Island Hospital, Providence, and colleagues investigated which women would benefit from short-term HT by weighing symptom relief against risks of causing disease.

The researchers developed a Web-based computer model to simulate the effects of short-term HT use (two years) on life expectancy and quality-adjusted life expectancy (QALE, a measurement of the number of high quality of life years that can be expected over the course of a lifetime) among 50-year-old menopausal women (without hysterectomy). The researchers based their model on findings from the Women's Health Initiative, which reported on some of the risks associated with HT.

The researchers found that among women without any symptoms of menopause, short-term HT was associated with overall losses in life expectancy and QALE of one to three months, depending on their risk of cardiovascular disease. Women with mild to severe menopausal symptoms gained three to four months or seven to eight months of QALE, respectively.

"Whether short-term HT is beneficial or harmful depends primarily on a woman's treatment goals, the severity of her estrogen-responsive symptoms, and her CVD risk," the authors write. "If the goal is to maximize longevity, HT is not advisable, since it is associated with small losses in life expectancy. However, if the goal is to maximize QALE, HT can be beneficial, especially among women at low CVD risk, among whom HT is associated with gains in QALE even when menopausal symptoms are mild," write the researchers.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 9, 2004
To contact corresponding author Kevin A. Schulman, M.D., call Kendall Morgan at 919/684-4148. To contact editorialist Knight Steel, M.D., call Anne Marie Campbell at 201/996-3763.

STUDY EXAMINES INAPPROPRIATE MEDICATION PRESCRIBING FOR ELDERLY PATIENTS

CHICAGO—Prescribing of inappropriate medications for elderly patients appears relatively common, according to an article in the August 9/23 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.

According to information in the article, persons 65 years or older make up less than 15 percent of the population, but make up nearly one-third of prescription drug users. Elderly persons are also more likely to take several drugs concurrently, the article states.

Lesley H. Curtis, Ph.D., of Duke University Medical Center, Durham, N.C., and colleagues investigated the extent of potentially inappropriate medication prescribing for elderly patients not in the hospital. Inappropriate medications were identified according to criteria set by physicians and pharmacologists, as defined by a list known as the Beers revised list of drugs - a list of drugs to be avoided in the elderly.

The researchers studied the outpatient claims database of a large national pharmaceutical benefit company. The database included 765,423 patients aged 65 or older who filled one or more prescription drug claims during 1999.

The researchers found that 162,370 patients (21 percent) filled a prescription for one or more drugs of concern (medications that should be avoided in elderly patients or which are inappropriate for use in elderly patients). Amitriptyline and doxepin (drugs used for treatment of depression) accounted for 23 percent of claims for Beers list drugs, and 51 percent of those claims were for drugs with potentially harmful effects. More than 15 percent of patients filled prescriptions for two drugs of concern, and 4 percent filled prescriptions for three or more drugs of concern within the same year.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 9, 2004
To contact Gail T. Tominaga, M.D., call Nancy Usui at 808/547-4780.

INJURED METHAMPHETAMINE USERS STAY IN THE HOSPITAL LONGER AND HAVE HIGHER HOSPITAL CHARGES

CHICAGO—Trauma patients who test positive for methamphetamine are more likely to be admitted to the hospital and have significantly higher hospital costs, according to an article in the August issue of the Archives of Surgery, one of the JAMA/Archives journals.

Methamphetamine use is a major health care problem in the United States, and rates of use appear highest in Hawaii, with 40 percent of people arrested in Honolulu testing positive for methamphetamine, according to the article. Methamphetamine can cause aggressive and erratic behavior, and severe exhaustion can result after a "high", which can last 6 to 12 hours or more.

Gail T. Tominaga, M.D., of The Queen's Medical Center, Honolulu, and colleagues investigated whether the use of methamphetamine affects hospital length of stay (LOS) in minimally injured trauma patients.

The researchers studied the records of 212 patients (aged 18 to 55 years) admitted to a trauma center between January 1, 2002 and December 31, 2002 who were injured and for whom toxicology screenings were performed to evaluate the patients for suspected suicide attempt or altered level of consciousness (i.e., decreased alertness).

Of the 212 patients, 57 tested positive for amphetamine or methamphetamine use. Patients who tested positive were more likely to have an intentional self-inflicted injury or intentional assaults than patients who tested negative (37 percent vs. 22 percent). Patients who tested positive were older (average age, 33.6 years vs. 29.9 years), were more likely to be admitted to the hospital (91 percent vs. 70 percent), had longer hospital stays (average LOS, 2.7 days vs. 1.7 days), and had significantly higher hospital charges (average cost, $15,617 vs. $11,600).

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 9, 2004
To contact Nicholas A. Beare, F.R.C.Ophth., e-mail: nbeare{at}btinternet.com.

RETINAL FINDINGS IN SEVERE MALARIA APPEAR RELATED TO DISEASE

CHICAGO—Retinal findings in children with severe forms of malaria (with brain involvement and severe anemia) appear related to disease outcomes such as prolonged coma and death, according to an article in the August issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.

According to the article, severe forms of malaria due to the parasite Plasmodium falciparum, still have high rates of death and disability (including coma) in sub-Saharan Africa, and cause 1.5 to 2.7 million deaths each year, mostly in African children with cerebral malaria (CM) or severe malarial anemia (SMA). Severe malaria is also associated with retinal disorders (retinopathy) which have been found in 77 percent of patients with CM, according to the article.

Nicholas A. Beare, F.R.C.Ophth., of Royal Liverpool University Hospital, England, and colleagues studied 326 children admitted to a central African hospital and treated for CM or SMA during two consecutive malaria seasons. The researchers investigated possible associations between the presence and severity of retinal signs and clinical outcomes in the children.

Of the 326 children, 278 had CM, and of those, 170 (61 percent) had retinopathy. Twenty-five of 47 children with SMA had retinopathy. For children with CM, retinopathy was associated with higher death rates, and more severe retinal signs were associated with increasing risk of death and prolonged time to recover consciousness from a comatose state.