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, December 12, 2005)
DRINKING TEA ASSOCIATED WITH LOWER RISK OF OVARIAN CANCER
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 12, 2005)
SPECIAL ONLINE PUBLICATION — TESTOSTERONE THERAPY MAY HELP ELDERLY MEN WITH MILD ALZHEIMER DISEASE
EYE CELL IMPLANTS IMPROVE MOTOR SYMPTOMS FOR PARKINSON PATIENTS
IMMUNOSUPPRESSIVE DRUG APPEARS EFFECTIVE IN REDUCING NEW BRAIN LESIONS IN MS PATIENTS
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 12, 2005)
CATARACT SURGERY RATES AND COSTS RELATED TO PHYSICIAN REIMBURSEMENT METHODS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 12, 2005
Media Advisory: To contact Susanna C. Larsson, M.Sc., e-mail
susanna.larsson{at}imm.ki.se.
DRINKING TEA ASSOCIATED WITH LOWER RISK OF OVARIAN CANCER
CHICAGO—Women who drank at least two cups of tea a day had a lower risk of ovarian cancer than those who did not drink tea, according to a study in the December 12/26 issue of the Archives of Internal Medicine, one of the JAMA/Archives journals.
Evidence from laboratory studies indicates that green and black tea preparations may protect against various cancers. But few epidemiological studies have examined the relationship specifically between tea consumption and the risk of ovarian cancer, according to background information in the article.
Susanna C. Larsson, M.Sc., and Alicja Wolk, D.M.Sc., of the National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden, prospectively examined the association between tea consumption and the risk of ovarian cancer in 61,057 women, aged 40 to 76, who were participants in the population-based Swedish Mammography Cohort. Participants completed a validated 67-item food frequency questionnaire at enrollment between 1987 and 1990, and were followed for cancer incidence through December 2004. At baseline, 68 percent of the participants reported drinking tea (mainly black tea) at least once per month. During an average follow-up of 15.1 years, 301 women were diagnosed as having invasive epithelial ovarian cancer.
"We observed a 46 percent lower risk of ovarian cancer in women who drank two or more cups of tea per day compared with non-drinkers," the authors report. "Each additional cup of tea per day was associated with an 18 percent lower risk of ovarian cancer."
Women who drank less than one cup of tea per day had an 18 percent lower risk of ovarian cancer than non-drinkers. The risk was 24 percent lower for women who drank one cup of tea per day.
"This association does not depend on lower coffee consumption among women with high tea consumption; coffee is not associated with ovarian cancer risk in this cohort," the authors write.
"In summary, our results from a large population-based cohort of Swedish women suggest that tea consumption may lower the risk of ovarian cancer," the authors conclude. "Because prospective data on this relationship are scarce, our findings need confirmation by future studies."
(Arch Intern Med. 2005;165:2683-2686. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by research grants from the Swedish Cancer Foundation and the Swedish Research Council/Longitudinal Studies, Stockholm, Sweden.
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, December 12, 2005
Media Advisory: To contact Po H. Lu, Psy.D., call Dan Page at 310-794-2265.
TESTOSTERONE THERAPY MAY HELP ELDERLY MEN WITH MILD ALZHEIMER DISEASE
CHICAGO—Testosterone replacement therapy may help improve the quality of life for elderly men with mild cases of Alzheimer's disease, according to a study posted online today that will appear in the February 2006 print issue of the Archives of Neurology, one of the JAMA/Archives journals.
"There is a compelling need for therapies that prevent, defer the onset, slow the progression, or improve the symptoms of Alzheimer disease (AD)," the authors provide as background information in the article. They note that hormonal therapies have been the focus of research attention in recent years since male aging is associated with a gradual progressive decline in testosterone levels. "The gradual decline in testosterone level is associated with decreased muscle mass and strength, osteoporosis, decreased libido, mood alterations, and changes in cognition, conditions that may be reversed with testosterone replacement." The authors add that the age-related decline in testosterone is potentially relevant to AD as previous studies have found significantly lower concentrations of the hormone in middle-aged and elderly men who developed AD.
Po H. Lu, Psy.D., from the David Geffen School of Medicine, University of California, Los Angeles, and colleagues conducted a 24-week, randomized study to evaluate the effects of testosterone therapy on cognition, neuropsychiatric symptoms, and quality of life in 16 male patients with mild AD and 22 healthy elderly men who served as controls. The study participants were randomized to receive packets of gel to apply on their skin that either contained testosterone or a placebo. Standardized tests were administered at least twice (baseline and end) during the study for the assessment of cognitive functions and quality of life.
"For the patients with AD, the testosterone-treated group had significantly greater improvements in the scores on the caregiver version of the quality-of-life scale," the researchers report. "No significant treatment group differences were detected in the cognitive scores at end of study, although numerically greater improvement or less decline on measures of visuospatial functions was demonstrated with testosterone treatment compared with placebo. In the healthy control group, a nonsignificant trend toward greater improvement in self-rated quality of life was observed in the testosterone-treated group compared with placebo treatment. No difference between the treatment groups was detected in the remaining outcome measures."
"In conclusion, the present results should be considered preliminary and do not warrant routine treatment of AD and healthy control men with testosterone. Future studies with larger sample sizes are needed before clinical decisions regarding testosterone therapy can be rationally based. For men with compromised quality of life, as reflected on the type of measure employed in this study, and who suffer from low serum T [testosterone] levels, testosterone therapy may be a reasonable consideration."
(Arch Neurol. 2006;63:1-9. 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, December 12, 2005
Media Advisory: To contact Natividad P. Stover, M.D., call Bob Shepard at 205-934-8934.
EYE CELL IMPLANTS IMPROVE MOTOR SYMPTOMS FOR PARKINSON PATIENTS
CHICAGO—A preliminary study suggests that implants of cells from the human retina improved motor symptoms in patients with Parkinson disease, and they appear to be safe and well tolerated, according to a report in the December issue of the Archives of Neurology, one of the JAMA/Archives journals.
Parkinson disease (PD) is a neurodegenerative disorder characterized by tremor, rigidity, postural instability, and slowed ability to start and continue movements. Most patients with PD require therapy with the medication levodopa to control symptoms three to five years after a diagnosis of PD. However, disease progression and long-term oral treatment with levodopa may lead to the development of motor fluctuations and dyskinesias (difficulty or distortion in performing voluntary movements). Human retinal pigment epithelial (RPE) cells produce levodopa and can be isolated from post mortem human eye tissue, grown in culture, and implanted into the brain attached to microcarriers. These implants have ameliorated the motor deficits in animal models of Parkinson disease, according to background information in the article. (The retinal pigment epithelium is the pigment cell layer found in the inner layer of the retina of the eye.)
Natividad P. Stover, M.D., of the University of Alabama at Birmingham, and colleagues conducted an open-label pilot study to evaluate the effect of unilateral implantation of human RPE cells attached to gelatin microcarriers. Six patients with advanced Parkinson disease received cell implants, which were inserted into the brain tissue. The researchers performed efficacy evaluations at one and three months after surgery, and then at six, nine, 12, 15, 18 and 24 months. Yearly follow-up visits are ongoing and will continue.
"The implants were well tolerated," the authors report. "We observed an average improvement of 48 percent at 12 months after implantation in the Unified Parkinson's Disease Rating Scale motor subscore with the patient in the off state, which was sustained through 24 months."
"Improvement was also observed in activities of daily living, quality of life, and motor fluctuations," they continue. "No off-state dyskinesias were observed."
"On the basis of the motor improvement and tolerability observed in this open-label study, a randomized, double-blind, placebo-controlled study has been initiated to more objectively test efficacy and continue to assess safety," the authors conclude.
(Arch Neurol. 2005;62:1833-1837. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported in part by a grant from the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., and Titan Pharmaceuticals, Inc., Somerville, N.J. Co-authors Drs. Schweikert and Allen and Mr. Cornfeldt are employees of and own stock or stock options in Titan Pharmaceuticals, Inc. Co-author Dr. Watts is a consultant for Titan Pharmaceuticals, Inc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 12, 2005
Media Advisory: To contact Luca Massacesi, M.D., e-mail
massacesi{at}unifi.it.
IMMUNOSUPPRESSIVE DRUG APPEARS EFFECTIVE IN REDUCING NEW BRAIN LESIONS IN MS PATIENTS
CHICAGO—A medication that reduces relapse rates in patients with multiple sclerosis (MS) appears to be effective in reducing new brain inflammatory lesions and is well tolerated, according to a study in the December issue of the Archives of Neurology, one of the JAMA/Archives journals.
The drug is azathioprine, an immunosuppressive agent that is well tolerated, easy to administer and monitor, and has been used for many years in the treatment of transplant rejections and autoimmune diseases. Azathioprine reduces relapse rates in MS patients, but its effects on the frequency and accumulation of new brain inflammatory lesions has not been studied in MS, according to background information in the article. MS is a disease of the central nervous system, marked by numbness, weakness, loss of muscle coordination, and problems with vision, speech, and bladder control.
Luca Massacesi, M.D., and colleagues at the University of Florence, Italy, conducted an open-label treatment study to evaluate the effect of azathioprine therapy on new brain lesion suppression in MS. They used magnetic resonance imaging (MRI) to evaluate brain lesions of 14 patients with relapse-remitting MS (RRMS) of short duration. RRMS is a form of the disease characterized by relapses, when new symptoms can appear and old ones resurface or worsen, followed by periods of remission, when the person fully or partially recovers from the deficits acquired during the relapse. The patients were evaluated for six months before and six months during treatment with azathioprine, and new lesions were evaluated during the same periods and after an additional six months.
"The results of this study show, for the first time, that the immunosuppressive agent azathioprine suppresses new brain lesions evaluated using MRI in patients with RRMS," the authors report.
"Indeed, the treatment induces remarkable new brain lesion reduction, stable for 12 months," they write. "This activity was obtained at doses that can be well tolerated and that are associated with low circulating lymphocyte numbers."
Adverse events were observed in six patients, mainly at the beginning of the evaluation period, but they were transient or reversed after dose reduction and no patient interrupted therapy. Neurologic disability was stable, and the relapse rate decreased consistently with the new brain lesion rate.
"If considered in the context of previous clinical trials, the present study indicates that azathioprine may represent an alternative to immunomodulatory medications specifically approved for RRMS," the authors conclude.
(Arch Neurol. 2005;62:1843-1847. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the Multiple Sclerosis Project of the Italian Istituto Superiore di Sanitá and by the Florence University Magnetic Resonance Imaging Centre.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, December 12, 2005
Media Advisory: To contact William Shrank, M.D., MSHS, call Amy Smith at 617-534-1603.
CATARACT SURGERY RATES AND COSTS RELATED TO PHYSICIAN REIMBURSEMENT METHODS
CHICAGO—A system in which physicians are reimbursed for each procedure they perform (fee-for-service) is associated with a significantly higher rate of cataract surgery and related surgical costs, compared to a system in which physicians receive a lump sum for each patient they manage (contact capitation), according to a study in the December issue of the Archives of Ophthalmology, one of the JAMA/Archives journals.
A variety of studies have evaluated the influence of physician incentive and reimbursement systems on the provision of services. Many of those studies have evaluated practice patterns in the primary care setting, and the majority of them confirmed expectations that financial incentives to provide less care result in decreased hospitalization, resource use, and costs, although not universally, according to background information in the article. Under the fee-for-service (FFS) system, physicians are reimbursed for each procedure, and under the contact capitation (CC) system, physicians are provided a lump sum for each patient they manage.
William Shrank, M.D., MSHS, who was with the Veterans Affairs Greater Los Angeles Health Care System at the time of the research, and colleagues compared the effects of FFS and CC on cataract extraction rates and costs. (Dr. Shrank is now with Brigham and Women's Hospital, Harvard Medical School, Boston.) The researchers analyzed claims and other data for an average of 91,473 commercial beneficiaries and 14,084 Medicare beneficiaries receiving eye care from a network of ophthalmologists and optometrists in St. Louis, Mo., between 1997 and 1998. The rate of cataract extractions per 1,000 beneficiaries, the costs of cataract procedures, the rates of non-cataract procedures, and the level of professional reimbursement for providers were compared during the final six months of FFS physician reimbursement and the first six months of CC.
"Compared with fee-for-service, contact capitation reimbursement was associated with significant decreases in cataract extraction rates and costs," the authors report.
"Both commercial and Medicare beneficiaries were approximately one half as likely to have cataract extraction under contact capitation as compared with fee-for-service," they write. "Professional reimbursement increased by eight percent whereas facility fees for cataract procedures decreased by approximately 45 percent."
The study also found that cataract surgical rates decreased more dramatically than other ophthalmologic procedures after implementing CC.
"Cataract surgery is almost always an elective procedure, can be performed quickly with few complications, and the exact timing of surgery is subject to both the surgeon's judgment and influence," the authors write. "The finding that cataract surgery was more responsive to reimbursement methodology than other procedures supports the hypothesis that elective procedures are more responsive to physician incentives than non-elective procedures."
"As enthusiasm for linking physician reimbursement to the quality of care grows, more health plans will likely use quality standards to reward physicians in addition to a baseline of either FFS or fixed-payment methodologies," they conclude. "More study is needed to evaluate the relationship between costs, quality, and combinations of physician reimbursement incentives and methodologies."
(Arch Ophthalmol. 2005;123:1733-1738. 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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