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 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, September 26, 2005
STATINS USE ASSOCIATED WITH LOWER RISK OF FRACTURES
ONLINE EDUCATIONAL PROGRAM APPEARS TO IMPROVE PHYSICIANS' KNOWLEDGE ABOUT DISEASES CAUSED BY BIOTERRORISM AGENTS
POOR HEALTH LITERACY ASSOCIATED WITH POORER PHYSICAL AND MENTAL HEALTH
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 26, 2005
Media Advisory: To contact Richard E. Scranton, M.D., M.P.H., call James Blue at 917-763-9972.
STATINS USE ASSOCIATED WITH LOWER RISK OF FRACTURES
CHICAGO—In a large study of elderly, predominately male veterans, statin use was associated with a 36 percent reduction in risk of fracture when compared with no lipid-lowering therapy, according to a study in the September 26 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Several biological mechanisms have been proposed to explain an association between statins and bone health, including reduced inflammation and promotion of new bone growth through improvements in small blood vessel function, according to background information in the article. Previous studies have shown an association between statin use and fracture reduction. However, most studies have been of populations of women even though many statin users are elderly men with heart disease. The authors suggest that assessing this relationship in a male population would be especially relevant.
Richard E. Scranton, M.D., M.P.H., of the Massachusetts Veterans Epidemiology Research and Information Center, Boston, and colleagues analyzed data from patients who received care in the V.A. health care system between January 1, 1998, and June 30, 2001 to compare the rate of bone fractures in individuals using statins versus those not taking statins. Information on individuals' health status, race, age and body mass index (BMI) as well as other medications that might be associated with bone fracture were included in the analysis. Of the 91,052 individuals included in the study, 28,063 were prescribed only statins, 2,195 were prescribed nonstatin lipid-lowering medications alone, and the remaining 60,794 were not prescribed any lipid-lowering medications during the period of the study.
"More than 28,000 of these individuals were using statins, making this study one of the largest to evaluate the association between statins and fractures," the researchers report. "The use of statins in this study was associated with a 36 percent reduction in fracture risk compared with no lipid-lowering therapy and a 32 percent risk reduction when compared with other lipid-lowering therapy. These findings did not deviate significantly after adjustment for various covariates, including BMI."
"In our large cohort of mostly male veterans, statin therapy was associated with a reduction in fractures," the authors conclude. Our study represents one of the largest studies to date of individuals receiving statins and the evaluation of fracture risk. Although we were limited in adjusting for all known confounders, this study provides additional information that fuels the debate of whether statins protect individuals against fractures. Further research is necessary to confirm or refute our findings."
(Arch Intern Med.
2005;165:2007-2012. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institutes of Health, Bethesda, Md., the Arthritis Foundation, Atlanta, Ga., and the Department of Veterans Affairs, Washington, D.C.
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, September 26, 2005
Media Advisory: To contact corresponding author Stephen D. Sisson, M.D., call Gary Stephenson at 410-955-5384.
ONLINE EDUCATIONAL PROGRAM APPEARS TO IMPROVE PHYSICIANS' KNOWLEDGE ABOUT DISEASES CAUSED BY BIOTERRORISM AGENTS
CHICAGO—An online education program improved physicians' knowledge about the diagnosis and management of diseases caused by bioterrorism agents, such as anthrax, smallpox and plague, according to a study in the September 26 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
In the event of a biologic attack, physicians will be first responders and represent the front line of defense, but little is known about the ability of physicians to appropriately diagnose and treat patients infected with bioterrorism agents, according to background information in the article. Physicians who are not prepared might be effectively taught to diagnose and treat patients presenting with any of these diseases through computer-assisted instruction, the authors suggest.
Sara E. Cosgrove, M.D., M.S., of The Johns Hopkins University School of Medicine, Baltimore, and colleagues conducted an online educational program for physicians from 30 internal medicine residency programs in 16 states and Washington, D.C. between July 1, 2003 and June 10, 2004. Six hundred thirty-one physicians completed the course, including a pretest assessment of their knowledge about diagnosis and management of cases of smallpox, anthrax, botulism and plague and a post-test assessment following the completion of the course.
On the pretest, correct diagnosis of diseases due to bioterrorism agents were smallpox, 50.7 percent; anthrax, 70.5 percent; botulism, 49.6 percent; and plague, 16.3 percent, (average, 46.8 percent) the researchers report. Correct diagnosis averaged 79.0 percent after completion of the course. Correct management of smallpox in the pretest was 14.6 percent; anthrax, 17.0 percent; botulism, 60.2 percent; and plague 9.7 percent (average, 25.4 percent). Correct management averaged 79.1 percent after course completion. Residents did not differ in performance based on years in training, although attending physicians (n=30) did perform better than residents.
"The significant improvement in posttest scores among responders at all levels of training suggests that physicians can be trained using an online case-based format to learn how to diagnose and manage infection caused by category A bioterrorism agents," the authors write. "This study demonstrates that physician knowledge about diagnosis and treatment of patients presenting with infection or exposure to a likely bioterrorism agent is poor, and adds physician education to the list of priorities the government should undertake to prepare for what many see as an inevitable event. The Internet can be used to distribute a curriculum to teach physicians to diagnose and care for patients exposed to or infected with a likely bioterrorism agent. Early recognition is essential to minimize the potentially devastating impact of a bioterror attack."
(Arch Intern Med.
2005;165:2002-2006. Available pre-embargo to the media 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, September 26, 2005
Media Advisory: To contact Michael S. Wolf, Ph.D., M.P.H., call Liz Crown at 312-503-8928.
To contact editorial author Darren A. DeWalt, M.D., M.P.H., call Stephanie Crayton at 919-966-2860.
POOR HEALTH LITERACY ASSOCIATED WITH POORER PHYSICAL AND MENTAL HEALTH
CHICAGO—Health problems that place limitations on daily activities and result in pain that interferes with normal work activities were more common among older individuals with poor health literacy, according to a study in the September 26 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
The Institute of Medicine reports that 48 percent of adults in the U.S. have inadequate health literacy, defined as the ability to obtain, process and understand basic information and services needed to make appropriate decisions regarding health, according to background information in the article. Besides basic reading skills, individuals need to be able to read and understand numerical information such as that on prescription bottles and be able to read and interpret document information such as appointment slips.
Michael S. Wolf, Ph.D., M.P.H. of the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues used data from a survey of 2,923 Medicare enrollees in Cleveland, Houston, Tampa, and Fort Lauderdale-Miami, Fla. In a one-hour in-person interview, individuals' physical and mental health status were assessed. Questions included medical history, alcohol and tobacco use and height and weight. Standardized mental and physical health test scores were determined. The average age of participants was 71 years.
Approximately one third of those surveyed had marginal (11 percent) or inadequate (22.2 percent) health literacy. Individuals with lower health literacy were more likely to have never smoked and to abstain from alcohol than individuals with adequate health literacy, the researchers report. Individuals with inadequate health literacy had significantly higher rates of certain chronic conditions, including high blood pressure, diabetes mellitus, heart failure and arthritis. Individuals with inadequate health literacy were more likely to report activity limitations related to health, including activities of daily living and pain that "quite a bit" or "extremely" interfered with normal work activities. "The magnitude of these associations were large and clinically important," the authors write.
Previous studies have suggested that inadequate health literacy is linked to worse knowledge of proper health behaviors and lower adherence to medical instructions; that despite access to health care the quality of medical encounters may be compromised when health care providers do not communicate at a level that is understood; and that patient education materials may be too complex or written at too high a level to be helpful. "Over time, these factors could contribute to the worse health status seen among the older patients with low health literacy in this study," the authors suggest.
"Although the causal pathways between low health literacy and disease-specific health outcomes remain unclear, this study provides further evidence of the likelihood that inadequate health literacy detrimentally affects health," the authors conclude. "To develop appropriate and responsive interventions, future studies should discern how adults with lower health literacy recognize health issues, and they should identify barriers to seeking out appropriate health care services. In addition, interventions are needed that can help physicians and other health care professionals recognize and address the special needs of patients with limited health literacy."
(Arch Intern Med. 2005;165:1946-1952. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Wolf was supported by a career development award from the Centers for Disease Control and Prevention, Atlanta, Ga.
EDITORIAL: READING IS FUNDAMENTAL
The Relationship Between Literacy and Health
In an editorial accompanying the article, Darren A. DeWalt, M.D., M.P.H., and Michael P. Pignone, M.D., M.P.H., of the University of North Carolina School of Medicine, Chapel Hill, write, "The study by Wolf and colleagues substantially expands our understanding of the relationship between low literacy and adverse outcomes. ...Patients with low literacy were also more likely to report having diabetes mellitus and heart failure but were not more likely to have asthma, cancer, or coronary artery disease. The relationship between literacy and the prevalence of chronic diseases has not been previously reported in such detail, to our knowledge. The finding of a higher prevalence of certain chronic conditions among people with low literacy is important because it raises the question about the role of literacy in the development of chronic conditions, rather than the common notion that literacy is most important once one develops a health problem. ...we can theorize that low literacy could have a causal role in their development."
"After the important study reported herein, we have more knowledge of the relationship between literacy and the prevalence of chronic disease, which opens the door for important inquiries about the reasons for these associations," the authors conclude. "Furthermore, these analyses offer the most rigorous estimates that we are aware of to date of the relationship between literacy and important patient-reported outcomes. As the evidence continues to build, we are more and more convinced that reading is fundamental, and one's health may depend on it."
(Arch Intern Med.
2005;165:1943-1944. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Drs. DeWalt and Pignone have received grants and honoraria from Pfizer for work related to health literacy.
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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