JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 8, 2005)
DUTCH PHYSICIANS' RESPONSES TO REQUESTS FOR EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE
HOSPITAL CHARACTERISTICS PLAY A ROLE IN USE OF DO-NOT-RESUSCITATE ORDERS
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 8, 2005)
COSMIC RADIATION ASSOCIATED WITH RISK OF CATARACT IN AIRLINE PILOTS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 8, 2005)
SPECIAL ONLINE PUBLICATION — ELEVATED INSULIN LEVELS APPEAR TO INCREASE LEVELS OF INFLAMMATORY MARKERS AND BETA-AMYLOID, WHICH MAY CONTRIBUTE TO ALZHEIMER'S DISEASE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 8, 2005
To contact corresponding author Bregje D. Onwuteaka-Philipsen, Ph.D., e-mail: b.philipsen{at}vumc.nl. To contact Editorial Author Susan M. Wolf, J.D., call Libby Washburn at 612-625-1538.
DUTCH PHYSICIANS' RESPONSES TO REQUESTS FOR EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE
CHICAGO—Physicians in the Netherlands rely on careful patient evaluations and official practice guidelines when considering patient requests for euthanasia and physician-assisted suicide (EAS), according to a study in the August 8/22 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
In Oregon, Belgium and the Netherlands physicians are permitted to perform euthanasia or physician-assisted suicide if specific official requirements are met, according to background information in the article. Because of the complexity of an EAS request and decision, several types of situations can arise: the request can be granted and EAS performed, patients can die of natural causes before the performance of EAS or before the decision is made, the patient can withdraw the request or the request can be refused.
Marijke C. Jansen-van der Weide, M.Sc., of VU University Medical Center, Amsterdam, the Netherlands, and colleagues surveyed all general practitioners in 18 of 22 Dutch general practice districts. Physicians received a written questionnaire in which they were asked about the number of requests for EAS they had received in the last 12 months and how they had dealt with those requests. In addition, physicians were asked to describe in detail the most explicit request for EAS received in the last 18 months, including patient symptoms, the extent to which the patient's situation met the official requirements for accepted practice and the decision-making process.
A total of 3,614 general practitioners responded to the questionnaire (60 percent response rate). Forty-four percent of all explicit requests for EAS resulted in the granting and performance of EAS, the researchers report. The patient died before the performance of the request in 13 percent of cases, or before the final decision was made in 13 percent of cases. The patient withdrew the request in 13 percent of cases and the physician refused the request 12 percent of the time. The most frequent reasons for requesting EAS were "pointless suffering," "loss of dignity" and "weakness." The patients' situation met the official requirements for accepted practice best in requests that were granted and least in refused requests. Refusal of requests were associated with a lesser degree of competence, and less unbearable and hopeless suffering.
"The complexity of EAS decision making is reflected in the fact that besides granting and refusing a request, three other situations could be distinguished," the authors conclude. "The decisions physicians make, the reasons they have for their decisions, and the way they arrive at their decisions seem to be based on patient evaluations. Physicians report compliance with the official requirements for accepted practice."
(Arch Intern Med. 2005;165:1698-1704. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by the Royal Dutch Medical Association (Utrecht) and the Dutch Ministry of Health, Welfare, and Sports (The Hague).
EDITORIAL: ASSESSING PHYSICIAN COMPLIANCE WITH THE RULES FOR EUTHANASIA AND ASSISTED SUICIDE
In an editorial accompanying the article, Susan M. Wolf, J.D., of the University of Minnesota Law School, writes, "The ultimate question remains-if you permit physicians to take life deliberately by assisting suicide or performing euthanasia, can you control the practice? … Determining the answers will require detailed study in each health system and culture permitting assisted suicide or euthanasia. The Dutch have struggled mightily for more than two decades to devise a system to oversee physician-assisted suicide and euthanasia and keep both practices within agreed bounds. It is not clear that they have succeeded. Yet even if they were to succeed, that system might not work in the United States. The Dutch have universal health care coverage, long-standing relationships between physician and patient, and a far more homogenous society."
"Virtually all agree that it is irresponsible to permit assisted suicide and euthanasia without safeguards," Wolf concludes. "There must be limits and an effective way to police them. Yet it remains unclear that we know how to restrain these practices and assure physician reporting. The Dutch should be commended for wrestling with this problem. But even they may not have the answer to this immensely difficult question."
(Arch Intern Med. 2005;165:1677-1678. Available to the media pre-embargo at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 8, 2005
Media Advisory: To contact David S. Zingmond, M.D., Ph.D., call Rachel Champeau 310-794-2270.
HOSPITAL CHARACTERISTICS PLAY A ROLE IN USE OF DO-NOT-RESUSCITATE ORDERS
CHICAGO—Hospital characteristics, including size, non-profit status and affiliation with a university, appear to be associated with use of do-not-resuscitate orders (DNR) in California, independent of the patient's characteristics, according to a study in the August 8/22 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Do-not-resuscitate orders are essential for guiding the care provided to hospitalized patients, according to background information in the article. Treatments like resuscitation may be inappropriate or may afford short-term benefits without achieving valued long-term goals. If DNR orders reflect patients' preferences and guide care that is consistent with these preferences, DNR orders can be considered indicators of the quality of health care at an institution, the authors suggest.
David S. Zingmond, M.D., Ph.D., and Neil S. Wenger, M.D., M.P.H., of The David Geffen School of Medicine at UCLA, Los Angeles, analyzed records from California hospitals to determine whether institutional factors were associated with the use of DNR orders. The researchers assessed the association between hospital characteristics, (size, profit status and academic status) and the use of a DNR order written within the first 24 hours of admission. The researchers also assessed whether there were regional differences in the use of DNR orders. Of approximately one and half million patients 50 or older admitted for acute care during 2000, the researchers included in their analysis 819,686 admissions at 386 California hospitals for 40 of the most common medical and surgical/procedural diagnoses-related groups (DRGs).
The researchers found that the percentage of DNR orders written within the first 24 hours of admission varied from two percent for patients aged 50-59 years to 17 percent for patients 80 years or older. The odds of having early DNR orders written were significantly lower in for-profit vs. private non-profit hospitals, were higher in the smallest vs. the largest hospitals, and were lower in academic vs. non-academic institutions. The rate of DNR order use varied by 10-fold depending on region with the highest rates in rural areas, the authors report.
"The initiation of end-of-life discussions and the implementation of DNR orders are important toward ensuring that patients receive care appropriate to their prognosis and preferences," the authors conclude. "Hospital characteristics appear to be associated with the use of DNR orders, even after accounting for differences in patient characteristics. This association reflects institutional culture, technological bent, and physician practice patterns."
(Arch Intern Med. 2005;165:1705-1712. Available to the media pre-embargo at www.jamamedia.org)
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 8, 2005
Media Advisory: To contact Vilhjalmur Rafnsson, M.D., Ph.D., call 354-893-5415 (Iceland is 5 hours ahead of CT).
COSMIC RADIATION ASSOCIATED WITH RISK OF CATARACT IN AIRLINE PILOTS
CHICAGO—Airline pilots have an increased risk of nuclear cataracts [common type of cataract, associated with aging] compared with non-pilots, and that risk is associated with cumulative exposure to cosmic radiation, according to a study in the August issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.
Commercial airline pilots are reported to be at an increased risk for some cancers, but studies on the biological effects of their exposure to cosmic radiation have been limited, according to background information in the article. Previous studies have shown that cataracts can be caused by exposure to radiation, including a recent study of astronauts showing an association of incidence of cataracts with space radiation at exposure levels comparable to those of commercial airline pilots.
Vilhjalmur Rafnsson, M.D., Ph.D., of the University of Iceland, Reykjavik, and colleagues conducted a case control study involved 445 men to determine whether employment as a pilot is associated with lens opacification. The cases included 71 men with nuclear cataract, and the controls (n = 374) were those men with different types of lens opacification or without lens opacification. Among the 445 men, 79 were commercial pilots and 366 had never been pilots. All participants in the study were 50 years or older and other factors that contribute to cataract risk, including smoking, age and sunbathing, were controlled for in the statistical analysis. Exposure to cosmic radiation was assessed based on employment time as pilots, annual number of hours flown on each aircraft type, time tables, flight profiles and individual cumulative radiation doses calculated by computer.
Among the 71 cases with nuclear cataract, 15 were employed as commercial pilots, whereas among the 374 controls (without nuclear cataract), 64 were employed as pilots.
"The odds ratio for nuclear cataract risk among cases and controls was 3.02 for pilots compared with nonpilots, adjusted for age, smoking status, and sunbathing habits," the researchers report. The researchers found an association between the estimated cumulative radiation dose and the risk of nuclear cataract.
"The association between the cosmic radiation exposure of pilots and the risk of nuclear cataracts, adjusted for age, smoking status, and sunbathing habits, indicates that cosmic radiation may be a causative factor in nuclear cataracts among commercial airline pilots," the authors conclude.
(Arch Ophthalmol. 2005;123:1102-1105. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the University of Iceland Research Fund, and the Helga Jonsdottir and Sigurlidi Kristjansson Memorial Fund, Reykjavik, Iceland. All of the authors have frequently traveled on Icelandair and other airline companies. They have no financial connections with the airline company or the pilots' union.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 8, 2005
Media Advisory: To contact corresponding author Suzanne Craft, Ph.D., call Geri Rowe at 206-764-2435.
ELEVATED INSULIN LEVELS APPEAR TO INCREASE LEVELS OF INFLAMMATORY MARKERS AND BETA-AMYLOID, WHICH MAY CONTRIBUTE TO ALZHEIMER'S DISEASE
CHICAGO—Moderately elevated levels of insulin increase the levels of inflammatory markers and beta-amyloid in plasma and in cerebrospinal fluid, and these markers may contribute to Alzheimer's disease, according to a new study posted online today from Archives of Neurology, one of the JAMA/Archives journals. The study will be published in the October print edition of the journal.
According to background information in the article, "conditions of insulin resistance and hyperinsulinemia are associated with elevated levels of inflammatory markers and increase the risk for Alzheimer disease (AD). Inflammation has been proposed as a key pathogenic factor for AD."
Mark A. Fishel, M.D., from the University of Washington, Seattle, and colleagues, raised blood insulin levels (while maintaining normal blood sugar levels) in 16 healthy older adults ranging in age from 55 to 81 years, and then measured the changes in levels of inflammatory markers, modulators, and beta-amyloid (a protein associated with AD) in plasma and cerebrospinal fluid.
"Moderate peripheral hyperinsulinemia (increased levels of insulin) provoked striking increases in CNS (central nervous system) inflammatory markers," the authors report. "Our findings suggest that insulin-resistant conditions such as diabetes mellitus and hypertension may increase the risk for AD, in part through insulin-induced inflammation."
"Although this model has obvious relevance for diabetes mellitus, hyperinsulinemia and insulin resistance are widespread conditions that affect many nondiabetic adults with obesity, impaired glucose tolerance, cardiovascular disease, and hypertension. Our results provide a cautionary note for the current epidemic of such conditions, which, in the context of an aging population, may provoke a dramatic increase in the prevalence of AD. More encouragingly, greater understanding of insulin's role in AD pathogenesis may lead to novel and more effective strategies for treating, delaying, or even preventing this challenging disease," the authors conclude.
(Arch Neurol. 2005;62:1-6. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by the Department of Veterans Affairs, Washington, D.C., by grants from the National Institute on Aging, Bethesda, Md., and by the Alvord Endowment, University of Washington, Seattle.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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