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.

JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, July 26, 2005)

JAMA NEWS RELEASES

   CLINICAL FACTORS CAN HELP DETERMINE RISK OF PROSTATE CANCER DEATH FOLLOWING 'BIOCHEMICAL' CANCER RECURRENCE AFTER RADICAL PROSTATECTOMY

   EXPOSURE TO PESTICIDES IN SCHOOLS PRODUCES ILLNESSES AMONG SCHOOL EMPLOYEES AND STUDENTS

   BLOOD PRESSURE CONTROL AND TREATMENT IS LOW, ESPECIALLY AMONG OLDER WOMEN WITH HYPERTENSION

   DELIVERY OF ROUTINE PREVENTIVE SERVICES SUBOPTIMAL FOR MEDICARE BENEFICIARIES

JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)

   VIDEO: Windows Media | Quicktime

   MAJORITY OF PEOPLE OVER AGE 80 HAVE HIGH BLOOD PRESSURE, YET MOST ARE NOT RECEIVING EFFECTIVE TREATMENT

INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.

TV Note: This week's JAMA video news release is on the current prevalence and treatment of hypertension in the elderly. The release will be fed Tuesday, July 26, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).

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Embargoed for Release: 3 p.m. CT, Tuesday, July 26, 2005
Media Advisory: To contact Stephen J. Freedland, M.D., call Trent Stockton at 410-955-8665. To contact Anthony V. D'Amico, M.D., Ph.D., call Melanie Franco at 617-534-1605. To contact editorial author Mitchell S. Anscher, M.D., call Becky Levine at 919-660-1308.

CHICAGO—Clinical factors including the time to biochemical recurrence following surgery can help predict the risk of prostate cancer death for patients following a radical prostatectomy, according to a study in the July 27 issue of JAMA.

Radical prostatectomy (removal of the prostate) is one of the most common treatments for prostate cancer and generally provides excellent cancer control, according to background information in the article. However, approximately 35 percent of patients will develop a prostate-specific antigen (PSA) recurrence ("biochemical recurrence") within 10 years after surgery. Due to the sensitivity of PSA to detect disease recurrence early, many patients have a long interval between biochemical recurrence and the development of local recurrence or distant metastasis.

Given the protracted natural history, the researchers had previously identified clinical variables to help stratify patients for risk of metastasis: time from surgery to biochemical recurrence, pathological Gleason score (a grading system for prostate tumors), and PSA doubling time (PSADT; the time it takes for the PSA value to double). Previous research has confirmed that a short PDADT is a risk factor for clinical progression and prostate cancer-specific death.

Stephen J. Freedland, M.D., of The Brady Urological Institute, Johns Hopkins Medicine, Baltimore, and colleagues conducted a study to 1) identify clinical factors that are associated with increased risk for prostate cancer-specific death following radical prostatectomy, and 2) to identify men who are at high risk and may benefit from aggressive treatment and as well as to identify those men who are at low risk and can be safely observed. The study included 379 men who had undergone radical prostatectomy between 1982 and 2000 and who had a biochemical recurrence. The average follow-up after surgery was 10.3 years.

The researchers found that PSA doubling time (less than 3.0 vs. 3.0-8.9 vs. 9.0-14.9 vs. 15.0 or more months), pathological Gleason score (7 or less vs. 8-10), and time from surgery to biochemical recurrence (3 or less vs. greater than 3 years) were all significant risk factors for time to prostate-specific death. Using these 3 variables, tables were constructed to estimate the risk of prostate cancer-specific survival at year 15 after biochemical recurrence.

Patients with a PSADT less than 3 months had a median survival of 6 years. Patients with a PSADT less than 3 months, biochemical recurrence 3 years or less after surgery, and a pathological Gleason score of 8-10 had a median survival of 3 years. Patients with a PSADT of 15 or more months and a biochemical recurrence more than 3 years after surgery had a 100 percent prostate cancer-specific survival.

"Using the current data, patients at high risk of death due to prostate cancer can be identified. These patients should be offered aggressive combined multimodality treatment using hormonal and cytotoxic chemotherapy, particularly in light of recent data suggesting that chemotherapy can modestly, but significantly, prolong survival in patients with hormone refractory disease," the authors write.
(JAMA. 2005;294:433-439. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: For funding/support information, please see the JAMA article.

RATE OF INCREASE IN PSA VALUE PRIOR TO DIAGNOSIS OF PROSTATE CANCER PREDICTS RISK OF DEATH FOLLOWING RADIATION THERAPY

Men who have a higher rate of increase in their PSA value in the year prior to their prostate cancer diagnosis have a significantly higher risk of death following radiation therapy, according to a study in this issue of JAMA.

Information obtained from serial PSA values in the form of a PSA velocity (i.e., the change in PSA level during the year prior to diagnosis) has been shown to be significantly associated with tumor stage, grade, time to prostate cancer-specific death following radical prostatectomy, according to background information in the article.

Anthony V. D'Amico, M.D., Ph.D., of Brigham and Women's Hospital and the Dana Farber Cancer Institute, Boston, and colleagues evaluated whether a PSA velocity greater than 2.0 ng/mL during the year prior to diagnosis was significantly associated with prostate cancer-specific death following radiation therapy (RT). The study, conducted between January 1989 and December 2002, included 358 men treated with RT for localized prostate cancer. One-hundred twenty-five men were classified as having low-risk prostate cancer (clinical tumor category T1c or T2a and PSA level less than 10.0 ng/mL and Gleason score 6 or less; 233 men had higher-risk disease, stratified by the PSA velocity.

The researchers found that a PSA velocity greater than 2.0 ng/mL per year was significantly associated (12 times increased risk) with a shorter time to prostate cancer-specific death and all-cause death (2.1 times the risk) when compared with men whose PSA velocity was 2.0 ng/mL per year or less. Men presenting with low-risk disease and a PSA velocity greater than 2.0 ng/mL per year had a 7-year estimate of prostate cancer-specific death rate of 19 percent compared with 0 percent for men whose PSA velocity was 2.0 ng/mL per year or less. The corresponding values for men with higher-risk disease were 24 percent and 4 percent, respectively.

"Such men [higher PSA velocity] who are planning to undergo RT and are in good health could be considered for RT combined with androgen suppression therapy because this approach improves survival in men with higher-risk disease," the authors conclude.
(JAMA. 2005;294:440-447. Available pre-embargo to the media at www.jamamedia.org)

EDITORIAL: PSA KINETICS AND RISK OF DEATH FROM PROSTATE CANCER

In an accompanying editorial, Mitchell S. Anscher, M.D., of Duke University Medical Center, Durham, N.C., comments on the studies in this issue of JAMA on prostate cancer.

"As with most good retrospective studies, these 2 reports raise more questions than they answer. Given recent randomized trials reporting significant improvement in survival with chemotherapy for patients with hormone-refractory prostate cancer, a number of important questions persist: Is the definition of prostate cancer-specific mortality used in these studies still appropriate? In addition, which is the best index of change-in-PSA-with-time to use? Does it depend on the clinical situation; i.e., is PSA velocity more appropriate for newly diagnosed patients and PSADT more appropriate for patients recurring after primary therapy? What about patients who present with an abnormal result on their first-ever screening PSA measurement? Should the clinician wait 6 months and repeat the PSA measurement to calculate the PSA velocity? Also, should this information be used clinically at the present time, or are other nomograms [a chart or graphic representation of numerical relations that are connected by a line] better able to predict treatment outcome?"

"Good retrospective analyses serve to generate hypotheses for future clinical trials. The hypothesis that the rate of change in PSA with time predicts prostate cancer-specific mortality must be validated prospectively. If proven to be correct, progress in prostate cancer research will proceed at a much faster pace, since conclusive answers to clinical questions will be available in 5 to 10 years, rather than once per generation," Dr. Anscher concludes.
(JAMA. 2005;294:493-494. Available pre-embargo to the media at www.jamamedia.org)

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, Tuesday, July 26, 2005
Media Advisory: To contact Walter A. Alarcon, M.D., call Fred Blosser at 202-260-8519.

EXPOSURE TO PESTICIDES IN SCHOOLS PRODUCES ILLNESSES AMONG SCHOOL EMPLOYEES AND STUDENTS

CHICAGO—The rate of new illnesses associated with pesticide exposure at schools increased significantly in children from 1998 to 2002, according to an article in the July 27 issue of JAMA.

"Exposure to pesticides in the school environment is a health risk facing children and school employees," background information in the article states. Pesticides continue to be used both on and around school property, with some schools at risk of pesticide exposure from neighboring farms. Currently, no specific federal requirements on limiting pesticide exposures at schools exist. In the U.S. today, pesticide poisoning is often underdiagnosed.

Walter A. Alarcon, M.D., from the National Institute for Occupational Safety and Health, and the U.S Centers for Disease Control and Prevention, Cincinnati, and colleagues examined 1998 - 2002 data from 2,593 people with acute pesticide-related illnesses associated with school exposure. Information was collected from the National Institute for Occupational Safety and Health's Sentinel Event Notification System for Occupational Risks pesticides program (SENSOR) pesticides program, the California Department of Pesticide Regulation (CDPR), and the Toxic Exposure Surveillance System (TESS). Cases were included if illness developed after exposure to pesticide and illness was consistent with known toxicology of the pesticide.

The overall annual rates of new cases for 1998 - 2002 was 7.4 cases per million children, and was 27.3 cases per million school employee (adult) full-time equivalents. New case rates among children increased significantly from 1998 to 2002. Three cases (.1 percent) of high severity were found, 275 cases (11 percent) of moderate severity, and 2,315 cases (89 percent) of low severity were found. The majority of illnesses reported were associated with insecticides (n = 895, 35 percent), disinfectants (n = 830, 32 percent), repellents (n = 335, 13 percent), or herbicides (n = 279, 11 percent). Of 406 cases with detailed source information, 281 (69 percent) were associated with pesticides used at schools and 125 (31 percent) were associated with pesticide drift from farmland.

"These findings indicate that pesticide exposures at schools continue to produce acute illnesses among school employees and students in the United States, albeit mainly of low severity and with relatively low incidence rates," the authors write. "To prevent pesticide-related illnesses at schools, implementation of integrated pest management programs in schools, practices to reduce pesticide drift, and adoption of pesticide spray buffer zones around schools are recommended."
(JAMA. 2005;294:455-465. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: This study was supported by the U.S. government through the U.S. Environmental Protection Agency and the Centers for Disease Control and Prevention, which employs Drs. Alarcon, Calvert (co-author), and Blondell (co-author).

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, Tuesday, July 26, 2005
Media Advisory: To contact Donald M. Lloyd-Jones, M.D., Sc.M., call Elizabeth Crown at 312-503-8928.

BLOOD PRESSURE CONTROL AND TREATMENT IS LOW, ESPECIALLY AMONG OLDER WOMEN WITH HYPERTENSION

CHICAGO—Compared to current national guidelines, rates of blood pressure control in the community are low, especially among older women, according to a new study in the July 27 issue of JAMA.

"Elderly persons are among the fastest growing segments of the U.S. population and they have the highest prevalence of hypertension [high blood pressure]," according to the authors of the study. "Despite numerous trials demonstrating the benefits of blood pressure lowering among older individuals with hypertension, available data suggest that rates of treatment and control are suboptimal."

Donald M. Lloyd-Jones, M.D., Sc.M., from the Feinberg School of Medicine, Northwestern University, Chicago, and colleagues from the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Mass., analyzed data collected between January 1, 1990 and December 31, 1999 from that community-based cohort study to determine the current prevalence, patterns, treatment, control, and risks of hypertension in persons aged 80 years or older compared with younger individuals. There were 5,296 participants (2,317 men and 2,979 women) who were categorized by age: younger than 60 years, 60 to 79 years, or 80 years or older. Hypertension was defined as systolic blood pressure greater than or equal to 140 mm Hg (millimeters of mercury) or diastolic blood pressure greater than or equal to 90 mm Hg. Current national guidelines define normal blood pressure as systolic blood pressure 120 or less and diastolic blood pressure of 80 or less mm Hg. Patients were followed for up to 6 years for development of cardiovascular disease events.

"Prevalence of hypertension and drug treatment increased with advancing age, whereas control rates were markedly lower in older women (systolic < 140 and diastolic < 90 mm Hg)," the researchers found. "For ages younger than 60 years, 60 to 79, and 80 years and older, respectively, control rates were 38 percent, 36 percent, and 38 percent in men and 38 percent, 28 percent, and 23 percent in women." The researchers note that "the overall prevalence of treatment among participants with hypertension was 68.9 percent."

Among participants 80 years of age or older, major cardiovascular events occurred in 9.5 percent of those with normal blood pressure, 19.8 percent of the prehypertension group, 20.3 percent of the stage 1 hypertension group, and 24.7 percent of the stage 2 or treated hypertension group.

"Despite a wealth of evidence suggesting that thiazide diuretics (a type of medication) are the most cost effective agents for blood pressure reduction, and that they are particularly efficacious among the elderly, we found overall low rates of thiazide use, particularly among men," the researchers write. "We observed high prevalence of use of more expensive agents such as ACE inhibitors and other classes of drugs (e.g., alpha blockers), although data supporting their efficacy in older hypertensive patients are limited."

"With the aging of the population, the burden of hypertension is expected to increase significantly," the authors write. "It is rare to escape the development of hypertension with aging; even for individuals free of hypertension at age 65 years, the remaining lifetime risk of developing hypertension is approximately 90 percent." The authors conclude: "Short-term risks for cardiovascular disease are substantial, indicating the need for greater efforts at safe, effective risk reduction among the oldest patients with hypertension."
(JAMA. 2005;294:466-472. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Dr. Lloyd-Jones is supported by a grant from the National Heart, Lung, and Blood Institute. The Framingham Heart Study is supported by a contract from the National Institutes of Health/National Heart, Lung, and Blood Institute.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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Embargoed for Release: 3 p.m. CT, Tuesday, July 26, 2005
Media Advisory: To contact Hoangmai H. Pham, M.D., M.P.H., call Alwyn Cassil at 202-264-3484.

DELIVERY OF ROUTINE PREVENTIVE SERVICES SUBOPTIMAL FOR MEDICARE BENEFICIARIES

CHICAGO—Certain physician characteristics and practice-setting characteristics are associated with Medicare beneficiaries receiving routine preventive services below the national goals, according to a study in the July 27 issue of JAMA.

An emerging body of literature suggests that quality of care may vary in association with the characteristics of individual physicians and their practices, according to background information in the article.

Hoangmai H. Pham, M.D., M.P.H., of the Center for Studying Health System Change, Washington, D.C., and colleagues examined the relationship between attributes of physicians and their practices and the extent to which their Medicare patients received preventive services. The researchers analyzed data from 3,660 U.S. physician respondents to the 2000-2001 Community Tracking Study Physician Survey linked to claims data on 24,581 Medicare beneficiaries 65 years and older who were treated in 2001. Physician variables included training and qualifications and sex. Practice setting variables included practice type, size, sources of revenue, and access to information technology. Analyses were adjusted for patient demographics and multiple diseases, as well as community characteristics.

The researchers determined the proportion of eligible beneficiaries who received each of 6 preventive services: diabetic monitoring with hemoglobin A1c measurement, eye examinations, screening for colon or breast cancer, and vaccination for influenza or pneumococcus.

The researchers found that overall, the proportion of beneficiaries receiving services was below national goals. Physician and, more consistently, practice-level characteristics were both associated with differences in the delivery of services. The strongest associations were with practice type and the percentage of practice revenue derived from Medicaid. For instance, beneficiaries receiving usual care in practices with less than 6 percent of revenue from Medicaid were more likely than those with more than 15 percent of revenue derived from Medicaid to receive diabetic eye examinations (48.9 percent vs. 43 percent), hemoglobin A1c monitoring (61.2 percent vs. 48.4), mammograms (52.1 percent vs. 38.9 percent), colon cancer screening (10.0 percent vs. 8.5 percent), and influenza (50.2 percent vs. 39.2 percent) and pneumococcal (8.2 percent vs. 6.4 percent) vaccinations.

Other variables associated with delivery of preventive services after adjustment for patient and geographic factors included obtaining usual health care from a physician who worked in group practices of 3 or more, who was a graduate of a U.S. or Canadian medical school, or who reported availability of information technology to generate preventive care reminders or access treatment guidelines.

"We found that this shortfall is neither uniform for all beneficiaries nor explained entirely by characteristics of the beneficiaries such as their race or income level. Rather, it appears that some beneficiaries are treated in practice settings or by physicians who deliver preventive services at particularly low rates. Our results suggest that these variations in quality are substantial and seem to be greatly influenced by the structure and revenue sources of physician practices. If we can understand the mechanisms underlying these relationships, it would be much easier to identify the key leverage points for quality improvement," the authors conclude.
(JAMA. 2005;294:473-481. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: For funding/support information, please see the JAMA article.

For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.

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JAMA REPORTS

VIDEO: Windows Media | Quicktime

MAJORITY OF PEOPLE OVER AGE 80 HAVE HIGH BLOOD PRESSURE, YET MOST ARE NOT RECEIVING EFFECTIVE TREATMENT

VIDEO:
B-ROLL
Dr.Lloyd-Jones taking Jeanne’s blood pressure
Jeanne taking medication

AUDIO:
80-YEAR OLD JEANNE (jeen) CHEMERS’ (chem-ers) BLOOD PRESSURE IS 130 OVER 60 – PRETTY HEALTHY NUMBERS, THANKS TO HER BLOOD PRESSURE MEDICATIONS.

VIDEO:
SOT/FULL
@ :08
Super: Jeanne Chemers
Takes blood pressure medications
Runs :10

AUDIO:
"Without medication I would probably be about 155 over 85. High."

VIDEO:
B-ROLL
Elderly people walking outside
GFX/JAMA COVER

AUDIO:
MOST PEOPLE OVER AGE 80 HAVE HIGH BLOOD PRESSURE, ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

VIDEO:
SOT/FULL
@ :26
Super: Donald Lloyd-Jones, M.D., Sc.M.
Northwestern University
Runs :06

AUDIO:
"What we found is that among the oldest individuals, those 80 years of age and older, more than 75% have high blood pressure."

VIDEO:
B-ROLL
Dr. Lloyd-Jones and colleague looking at echocardiogram of heart
C/u of heart on computer screen

AUDIO:
BUT THAT’S NOT ALL. DR. DONALD LLOYD-JONES OF NORTHWESTERN UNIVERSITY AND HIS COLLEAGUES AT THE NATIONAL HEART, LUNG AND BLOOD INSTITUTE’S FRAMINGHAM HEART STUDY, MEASURED BLOOD PRESSURE AND HEART HEALTH IN MORE THAN 5-THOUSAND OLDER PEOPLE, TRACKING THEM FOR UP TO SIX YEARS.

VIDEO:
SOT/FULL
Donald Lloyd-Jones, M.D., Sc.M.
Northwestern University
Runs :11

AUDIO:
"When we look at control rates, that is how well do we control the blood pressure among people with hypertension, we’re doing a very poor job at getting the blood pressure down."

VIDEO:
B-ROLL
Very elderly man
Very elderly woman

AUDIO:
IN PEOPLE OVER AGE 80, ONLY 38 PERCENT OF MEN, AND JUST 23 PERCENT OF WOMEN, HAD THEIR HIGH BLOOD PRESSURE TREATED EFFECTIVELY. AND THERE’S MORE.

VIDEO:
SOT/FULL
Donald Lloyd-Jones, M.D., Sc.M.
Northwestern University
Runs :10

AUDIO:
"25 percent of the oldest people with hypertension had a major cardiovascular disease event within the next six years, meaning that they were hospitalized for stroke, a heart attack or heart failure."

VIDEO:
B-ROLL
Blood pressure cuff
Diuretic pills
Very elderly man
Very elderly couple

AUDIO:
SO THE RISKS OF HIGH BLOOD PRESSURE ARE REAL. AND MEDICATIONS SUCH AS THIAZIDE DIURETICS ARE A PROVEN AND COST-EFFECTIVE WAY TO LOWER BLOOD PRESSURE. BUT THE STUDY SHOWED THAT ONLY ABOUT A THIRD OF PEOPLE OVER AGE 80 WHO COULD BENEFIT FROM SUCH MEDICATIONS ARE TAKING THEM.

VIDEO:
SOT/FULL
Donald Lloyd-Jones, M.D., Sc.M.
Northwestern University
Runs :11

AUDIO:
"I have a lot of patients who are age 80 and older, and most of them say to me, "you know doctor, I’ve lived a long time and had a great life and I don’t care if I die at this point, but don’t let me have a big stroke."

VIDEO:
B-ROLL
Dr. Lloyd-Jones taking Jeanne’s blood pressure
Jeanne taking medication

AUDIO:
THE BEST WAY TO PREVENT STROKE IS TO CONTROL BLOOD PRESSURE. THAT’S WHY JEANNE SAYS SHE’LL HAPPILY TAKE HER THREE BLOOD PRESSURE MEDICATIONS, INCLUDING HER DIURETIC.

VIDEO:
SOT/FULL
Jeanne Chemers
Takes blood pressure medications
Runs :04

AUDIO:
"I would not be reluctant to take another medication if it’s going to help me."

VIDEO:
B-ROLL
Dr. Lloyd-Jones examining Jeanne with stethoscope

AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.