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 GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 3, 2005)
MEDICATION COMBINED WITH BEHAVIORAL INTERVENTION APPEARS EFFECTIVE IN TREATING TEEN HEROIN ADDICTION
EMERGENCY DEPARTMENTS MAY OFTEN UNDER-DIAGNOSE MENTAL DISORDERS IN YOUTH FOLLOWING SELF-HARM INCIDENT
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 3, 2005)
MANY PEDIATRICIANS SAY THEY WOULD NOT CONTINUE CARE FOR FAMILIES WHO REFUSE VACCINES
FITNESS-ORIENTED GYM CLASSES DEMONSTRATE MEASURABLE HEALTH BENEFITS FOR OVERWEIGHT CHILDREN
AMOXICILLIN USE DURING INFANCY MAY BE LINKED TO TOOTH ENAMEL DEFECTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 3, 2005
Media Advisory: To contact Lisa A. Marsch, Ph.D., e-mail marsch{at}ndri.org.
To contact editorial author Charles P. O'Brien, M.D., Ph.D., call Olivia Fermona at 215-349-5653.
MEDICATION COMBINED WITH BEHAVIORAL INTERVENTION APPEARS EFFECTIVE IN TREATING TEEN HEROIN ADDICTION
CHICAGO—In a comparison of two drugs prescribed to treat teenagers dependent on heroin and other opioids, the drug buprenorphine was more effective, especially in treatment retention, according to a study in the October issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
The use of heroin among adolescents has more than doubled in the past ten years, and the use of prescription opiates, including controlled release oxycodone (OxyContin) and hydrocodone bitartrate and acetaminophen (Vicodin), has also increased, according to background information in the article. Opiates are the second most commonly abused class of illicit drugs among adolescents, second only to marijuana. Despite the need to identify effective treatments, virtually no research has been conducted to systematically characterize or evaluate treatment interventions for adolescent heroin and opioid abusers.
Lisa A. Marsch, Ph.D., and colleagues at the University of Vermont, Burlington, evaluated the relative efficacy of buprenorphine hydrochloride and another drug, clonidine hydrochloride, in detoxification of opioid-dependent teenagers. (Dr. Marsch is now with the National Development and Research Institutes and St. Luke's-Roosevelt Hospital Center, New York.) Buprenorphine hydrochloride treats opiate addiction by preventing symptoms of withdrawal from heroin and other opiates. Clonidine hydrochloride belongs to a class of drugs known as alpha-blockers. It is commonly prescribed to treat high blood pressure.
The researchers conducted a double-blind, randomized, controlled trial in an outpatient research clinic at the University of Vermont from October 2001 to December 2003. A volunteer sample of 36 opiate-dependent adolescents (aged 13-18) took part in the study. They were randomly assigned to a 28-day, outpatient, medication-assisted withdrawal treatment with either buprenorphine or clonidine. Both drugs were provided along with behavioral counseling three times a week, and incentives contingent on opiate abstinence.
"Results clearly demonstrated that combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions," the authors report.
The major difference between the two medications was in treatment retention. Over the course of the 28-day detoxification program, 72 percent of those who received buprenorphine were retained in treatment, compared with 39 percent of the group receiving clonidine.
"Participants in both groups reported relief of withdrawal symptoms and drug-related human immunodeficiency virus risk behavior," the authors write. "Those in the buprenorphine condition generally reported more positive effects of the medication."
After detoxification, all teens in the study were offered continued treatment with the drug naltrexone hydrochloride, an alternative to methadone. A relatively high proportion of those in the buprenorphine group, 61 percent, accepted naltrexone treatment, compared with only five percent of those given clonidine. "Given the efficacy of naltrexone in promoting continued abstinence postdetoxification from opioids, this finding further underscores the importance of and likelihood of success with early intervention among opioid-dependent adolescents," the authors write.
"In sum, this research provides novel and clinically important empirical information regarding effective interventions for the largely unstudied and expanding population of opioid-dependent adolescents," they conclude. "Results demonstrate that buprenorphine combined with behavioral therapy is one such efficacious intervention for this population."
(Arch Gen Psychiatry. 2005;62:1157-1164. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was sponsored by a grant from the National Institute on Drug Abuse, Bethesda, Md., and research funds from the Department of Psychiatry and the College of Medicine at the University of Vermont, Burlington.
COMMENTARY: ADOLESCENT OPIOID ABUSE
In an accompanying commentary, Charles P. O'Brien, M.D., Ph.D., of the University of Pennsylvania/Philadelphia VA Medical Center, Philadelphia, discusses the findings and says Marsch and colleagues are to be congratulated for conducting a double-blind study among teenagers.
"Despite the fact that substance abuse usually begins in adolescence, there are very few controlled studies of treatments for this group of patients. The study by Marsch and colleagues shows that double-blind clinical trials can be conducted in this group of patients," he writes. "Given the sometimes unexpected responses of adolescents to medications that have only been studied in adults, such clinical trials are badly needed."
(Arch Gen Psychiatry. 2005;62:1165. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 3, 2005
Media Advisory: To contact Mark Olfson, M.D., M.P.H., call Craig LeMoult at 212-305-0820.
EMERGENCY DEPARTMENTS MAY OFTEN UNDER-DIAGNOSE MENTAL DISORDERS IN YOUTH FOLLOWING SELF-HARM INCIDENT
CHICAGO—Young people visiting an emergency department following an episode of deliberate self-harm are diagnosed with a mental disorder about half the time, according to a study in the October issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.
Deliberate self harm, such as self-poisoning and self-cutting or piercing, is an important risk factor for subsequent suicide, according to background information in the article. Although previous studies indicate that following self-poisoning young people are at extremely high risk of suicide, little is known about emergency department assessment, treatment and discharge following an act of deliberate self harm. Previous studies in Europe suggest that mental health evaluations may not be uniformly provided in emergency care of youth who deliberately harm themselves, but no information from the U.S. has been available.
Mark Olfson, M.D., M.P.H., of the Columbia University Medical Center, New York, and colleagues analyzed data from a nationally representative sample of emergency department visits from 1997 to 2002 by young people, aged seven to 24 years, after deliberate self-harm. The researchers assessed the data to determine the frequency with which young people making such emergency visits are diagnosed with mental disorders, are provided various medical and psychiatric treatments and are referred for inpatient and outpatient care.
The researchers found that between 1997 and 2002, the annual overall rate of emergency visits by persons seven to 24 years old for deliberate self-harm was 225.3 per 100,000 population. The rate was significantly higher for persons 15 to 19 and 20 to 24 years of age than for persons seven to 14. "Self-poisoning (67.2 percent) accounted for a majority of the deliberate self-harm visits followed by self-cutting/piercing (25.8 percent)," the researchers report. "Overall, roughly one-half (56.1 percent) of the patient visits resulted in a mental disorder diagnosis including 15.1 percent resulting in a depressive disorder diagnosis and 7.3 percent resulting in a substance use disorder diagnosis. … Psychotropic medications [medications with psychological effects] were provided in 12.1 percent of the patient visits, most commonly anxiolytics [anti-anxiety drugs] (6.2 percent)."
"Slightly more than one-half of the patient visits (56.1 percent) resulted in inpatient admission," the authors write. "In addition, 29.0 percent of the visits resulted in outpatient care referral; 5.8 percent resulted in referral to the emergency department for continuing care, 4.9 percent resulted in no follow-up care, and follow-up care was unspecified in 3.4 percent of the visits." A diagnosis of depressive disorder, a well-known and powerful risk factor for youth suicide, was strongly associated with inpatient admission.
"Mental disorders were diagnosed in roughly one-half of emergency visits by young people treated for episodes of deliberate self-harm," the authors conclude. "This suggests substantial underrecognition of mental illness and likely inadequate referral for follow-up mental health care. Further research is clearly needed to better understand the extent and reasons for problems with the detection of mental disorders during emergency department evaluations of young people following self-harm. In the meantime, efforts should be made to fortify mental health assessments. One promising strategy involves routine administration of rapid and efficient diagnostic instruments to all young people following deliberate self-inflicted harm. Improving mental health assessment of these young people provides an important opportunity for secondary prevention."
(Arch Gen Psychiatry. 2005;62:1122-1128. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 3, 2005
Media Advisory: To contact Erin A. Flanagan-Klygis, M.D., call Mary Ann Schultz at 312-942-7816.
To contact editorial author J.W. Hendricks, M.D., e-mail jwh{at}pac.pcc.com.
MANY PEDIATRICIANS SAY THEY WOULD NOT CONTINUE CARE FOR FAMILIES WHO REFUSE VACCINES
CHICAGO—More than one-third of pediatricians say they would dismiss a family from their practice for refusing all vaccinations, according to a study in the October issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
The rate of unvaccinated children has risen significantly since 1995, according to background information in the article. While most parents continue to believe that vaccination is important, a large number express concern about vaccine safety. Although most parents depend on their pediatrician's advice and counsel in their decision to vaccinate their children, when a parent refuses one or all vaccines the relationship between parent and pediatrician may be weakened. Some pediatricians may choose to end their participation in the care of children whose parents refuse vaccinations, the authors suggest.
Erin A. Flanagan-Klygis, M.D., of Rush Medical College, Chicago, and colleagues surveyed pediatricians who provide routine vaccinations in a primary care setting. The survey included questions on the pediatrician's experience and type of practice; a question asking the pediatrician to rate the importance of the seven most common vaccines; and a set of questions about parental vaccine refusal and the pediatrician's response, including reasons for dismissing a family from the pediatrician's practice.
Of the 302 pediatricians completing the survey, 85 percent (256) reported encountering a family refusal of at least one vaccine during the previous 12 months, the researchers report. Fifty-four percent (162) of pediatricians reported encountering a parent who refused all vaccines. Pediatricians reported that parental reasons for both partial and full refusal of vaccines were similar. The most common reasons were safety concerns, concern at giving multiple vaccines at once, philosophical reasons and religious beliefs.
"In the case of parents refusing specific vaccines, 82 (28 percent) said that they would ask the family to seek care elsewhere; for refusal of all vaccines, 116 (39 percent) of pediatricians said they would refer the family," the authors write. The most important factors for pediatricians in the decision to dismiss families who refuse vaccines were lack of shared goals and lack of trust. There were no significant differences between pediatricians who would dismiss families for vaccine refusal and those who would not with respect to age, sex, number of years in practice or number of patients seen per week.
"Does the practice of family dismissal, in fact, promote or undermine immunization for particular children or children as a group?" the authors write. "Might family dismissal generally damage relationships between pediatricians and families such that parents become less likely to seek or successfully obtain other needed primary preventive services or care for acute or chronic illness? Given the changing climate of confidence in childhood vaccination, future research should address these and other potential implications of practice dismissal in the face of parental vaccine refusal. The answers obtained may provide insight into the influence physician behavior has on the health and welfare of children and communities for many years to come."
(Arch Pediatr Adolesc Med. 2005;159:929-934. Available pre-embargo to the media at www.jamamedia.org.)
EDITORIAL: DOES IMMUNIZATION REFUSAL WARRANT DISCONTINUING A PHYSICIAN-PATIENT RELATIONSHIP?
In an editorial accompanying the article, J.W. Hendricks, M.D., of Pediatric and Adolescent Care, L.L.P., Tulsa, Okla., writes: "Dismissing a patient is a rare occurrence for most physicians. I have found a vaccine refusal form to be helpful in continuing a relationship with a family who refuses some or all vaccines. The form doesn't (and can't) address issues like 'mutual trust' or 'lack of shared goals for the child.' Although subjective, these two factors often weigh heavier than a simple refusal of recommended care. I feel a straightforward immunization refusal does not by itself damage trust, breach shared goals, or necessarily lead to a 'my way or the highway' confrontation. This is supported by a recent clinical report from the American Academy of Pediatrics Committee on Bioethics. A future survey to tease out these issues would be helpful."
(Arch Pediatr Adolesc Med. 2005;159:994. Available pre-embargo to the media at www.jamamedia.org.)
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 3, 2005
Media Advisory: To contact Aaron L. Carrel, M.D., call Cathy Mike at 608-262-6641.
To contact editorial author Oded Bar-Or, M.D., e-mail baror{at}mcmaster.ca.
FITNESS-ORIENTED GYM CLASSES DEMONSTRATE MEASURABLE HEALTH BENEFITS FOR OVERWEIGHT CHILDREN
CHICAGO—Overweight children who took part in lifestyle-focused, fitness-oriented gym classes showed significant improvement in body composition, fitness, and insulin levels, according to a study in the October issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Obesity and poor physical fitness constitute a health problem affecting an increasing number of children. Childhood obesity and poor physical fitness are associated with insulin resistance, type 2 diabetes mellitus, blood lipid abnormalities, and high blood pressure in later life, according to background information in the article. The causes of childhood obesity include a pervasive "toxic" environment that facilitates increased caloric intake and reduced physical activity. In order to alter the children's environment, the authors suggest, an effective strategy for prevention and treatment of childhood obesity must be pervasive and collaborative. The school setting is an attractive starting point for a collaborative effort.
Aaron L. Carrel, M.D., and colleagues at the University of Wisconsin, Madison, conducted a randomized, controlled study to determine whether a school-based fitness program can improve body composition, cardiovascular fitness level, and insulin sensitivity in overweight children. Fifty overweight middle school children were randomized to lifestyle-focused, fitness-oriented gym classes (the treatment group) or standard gym classes (the control group) for nine months. The children were evaluated for fasting insulin and glucose levels, body composition, and maximum oxygen consumption treadmill testing before the school year, and at the end of the school year. There were no differences in age, body mass index, or sex distribution between the groups at baseline.
Fitness-oriented gym classes were designed to make fitness and good nutrition fun and achievable and to maximize the amount of movement during the class period. Class size was limited to 14 students to allow for increased instructor attention, increased opportunity for motivation, and less time standing in line.
"Children enrolled in fitness-oriented gym classes showed greater loss of body fat, increase in cardiovascular fitness, and improvement in fasting insulin levels than control subjects," the authors report.
The authors say the study results suggest that school curricula may be an effective vehicle for increasing physical activity and improving cardiovascular health for children, and they believe further study is warranted. "In this study, even a small change in the amount of physical activity showed beneficial effects on body composition, fitness, and insulin levels in children. Similar benefits have been shown by lifestyle improvements in adults with known glucose intolerance," they write.
The authors emphasize that it is important to develop and evaluate interventions designed to start in childhood, because childhood obesity is predictive of adult obesity. They suggest partnering with school districts should be part of a public health approach to improving the health of overweight children.
"These findings should help to encourage the development of physical education programs that are effective in providing children with substantial amounts of physical activity," they conclude. "Clearly, however, an effective public health approach must promote increased physical activity inside and outside of school, as physical activity recommendations cannot be met through physical education alone."
(Arch Pediatr Adolesc Med. 2005;159:963-968. Available pre-embargo to the media at
www.jamamedia.org.)
Editor's Note: This study was supported by grants from Genentech Center for Clinical Research in Endocrinology, South San Francisco, Calif., and the University of Wisconsin Sports Medicine Classic Fund, Madison.
EDITORIAL: JUVENILE OBESITY
Is School-Based Enchanced Physical Activity Relevant?
In an editorial accompanying the article, Oded Bar-Or, M.D., of the Children's Exercise and Nutrition Centre, Hamilton, Ontario, writes that enhanced physical activity is a major pillar in the treatment of juvenile obesity. "To the practicing physician, who is not conversant with exercise sciences, a simple exercise prescription would be an increment of 30 minutes daily, above and beyond the activity already preformed by the patient. To free time for this added activity, the prescription should also include a 30-minute reduction in 'screen time' (computer, video, and, in particular, television). The detailed content of the added activity-preferably outdoors-is not important, as long as the child moves from one place to another and, especially, finds it FUN."
(Arch Pediatr Adolesc Med. 2005;159:996-997. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 3, 2005
Media Advisory: To contact corresponding author Steven M. Levy, D.D.S, M.P.H., call David Pedersen at 319-335-8032. To contact editorial author Paul S. Casamassimo, D.D.S., M.S., call Pam Barber at 614-722-4595.
AMOXICILLIN USE DURING INFANCY MAY BE LINKED TO TOOTH ENAMEL DEFECTS
CHICAGO—Use of the antibiotic amoxicillin during infancy appears to be linked to tooth enamel defects in permanent teeth, according to a study in the October issue of the Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Dental fluorosis, a result of exposure to excessive fluoride during enamel formation, is one of the most common developmental enamel defects, according to background information in the article. The clinical signs range from barely noticeable white flecks, to pits and brown stains. Amoxicillin is one of the most common antibiotics used among pediatric patients, mainly for treatment of otitis media-infection and inflammation of the middle ear. There has been some evidence that amoxicillin use could be associated with dental enamel defects, and, the authors suggest, even a small effect on dental enamel could have a significant effect on the public's dental health because of the widespread use of amoxicillin.
Liang Hong, D.D.S., M.S., Ph.D., of the University of Iowa, Iowa City, and colleagues assessed the association between dental fluorosis and amoxicillin use during early childhood. (Dr. Hong is now with the Department of Dental Public Health and Behavioral Science, University of Missouri - Kansas City.) The researchers analyzed data from the Iowa Fluoride Study, a prospective study investigating fluoride exposures, biological and behavioral factors, and children's dental health. They followed 579 participants from birth to 32 months, using questionnaires every three to four months to gather information on fluoride intake and amoxicillin use.
"The results show that amoxicillin use during early infancy seems to be linked to dental fluorosis on both permanent first molars and maxillary central incisors," the authors report. "Duration of amoxicillin use was related to the number of early-erupting permanent teeth with fluorosis."
By the age of one year, three-quarters of the subjects had used amoxicillin. By 32 months, 91 percent of participants had used amoxicillin. "Overall, 24 percent had fluorosis on both maxillary central incisors," the authors write.
Amoxicillin use from three to six months doubled the risk of dental fluorosis. "The significantly elevated risk for dental fluorosis associated with amoxicillin use during early infancy was found at all levels of statistical analyses, even after controlling for other potential risk factors, such as fluoride intake, otitis media infections, and breastfeeding," the authors report.
The authors emphasize that additional laboratory and clinical studies-including controlled animal studies with specified amoxicillin dosages, chemical analysis and histological examination of affected teeth, and additional well-designed epidemiological studies-are needed to confirm the results.
"The findings suggest that amoxicillin use in infancy could carry some heretofore undocumented risk to the developing teeth," they conclude. "While the results of this one study do not warrant recommendations to cease use of amoxicillin early in life, they do further highlight the need to use antibiotics judiciously, particularly during infancy."
(Arch Pediatr Adolesc Med. 2005;159:943-948. Available pre-embargo to the media at
www.jamamedia.org.)
Editor's Note: This study was sponsored by grants from the National Institutes of Health, Bethesda, Md.
EDITORIAL: AMOXICILLIN AND FLUOROSIS
Too Soon to Cap the Medicine Bottle?
In an editorial accompanying the article, Paul S. Casamassimo, D.D.S., M.S., of the Ohio State University College of Dentistry and Columbus Children's Hospital, writes that pediatricians have already reduced their use of amoxicillin to treat ear infections. "Looking back through decades on the repeated dental cautions about tetracycline, it took years and alternative drug choices to reshape clinical practice to reduce what was a far more obvious, generalized, and more difficult-to-treat cosmetic problem. If the choice is hearing loss and its sequelae or the possible risk of minor cosmetic disappointment, there is little doubt of what will happen. Frankly, at this point, the association between amoxicillin use and fluorosis needs further study, as Hong et al have suggested. … Until that time, the best course of action may be what both the medical and dental communities have advocated for a long time-careful, thoughtful, and appropriate use of both fluoride and antibiotics."
(Arch Pediatr Adolesc Med. 2005;159:995-996. 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.
Go back to the top.
