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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT, Tuesday, August 16, 2005)
JAMA NEWS RELEASES
HOSPITALIZATIONS BECAUSE OF CHICKEN POX DOWN DRAMATICALLY SINCE IMPLEMENTATION OF VACCINE
RECEIVING INITIAL TREATMENT FOR HEART ATTACK AT HOSPITAL DURING OFF-HOURS ASSOCIATED WITH POORER OUTCOMES
STUDY EXAMINES GLOBAL PREVALENCE OF KIDNEY FAILURE AMONG CRITICALLY ILL PATIENTS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
CHICKEN POX VACCINE REDUCED HOSPITALIZATIONS AND DOCTOR VISITS - REDUCED ANNUAL HEALTH CARE SPENDING BY $63 MILLION
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 impact of the chicken pox vaccine. The release will be fed Tuesday, August 16, 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, August 16, 2005
Media Advisory: To contact Fangjun Zhou, Ph.D., M.S., call Curtis Allen at 404-639-8487.
To contact editorial author Matthew M. Davis, M.D., M.A.P.P., call Krista Hopson at 734-615-5282.
HOSPITALIZATIONS BECAUSE OF CHICKEN POX DOWN DRAMATICALLY SINCE IMPLEMENTATION OF VACCINE
CHICAGO—Since the introduction of the varicella (chicken pox) vaccine in 1995, hospitalizations and doctor visits because of chicken pox have dropped dramatically, according to a study in the August 17 issue of JAMA.
Varicella vaccine is recommended for routine immunization of children aged 12 to 18 months and for older susceptible children and adults in the United States, according to background information in the article. Before its licensure in 1995, almost everyone developed chicken pox; thus, incidence approximated the birth cohort, with about 13,000 hospitalizations and 100 to 150 deaths annually. Varicella vaccine coverage has increased steadily, reaching 81 percent in 2002 among children aged 19 to 35 months nationally, while varicella disease incidence has declined in all age groups. However, data documenting the impact of vaccination on varicella-related health care utilization have previously been limited.
Fangjun Zhou, Ph.D., M.S., of the National Immunization Program, Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to determine the patterns of hospitalization and ambulatory visits for chicken pox and their associated medical expenditures in the United States, evaluating these factors beginning in 1994 (before availability of varicella vaccine) through 2002 (7 years after vaccine licensure). Data included enrollees (children and adults) of more than 100 health insurance plans of approximately 40 large U.S. employers.
The researchers found that from the prevaccination period to 2002, hospitalizations due to chicken pox declined by 88 percent (from 2.3 to 0.3 per 100,000 population) and ambulatory visits declined by 59 percent (from 215 to 89 per 100,000 population). Hospitalizations and ambulatory visits declined in all age groups, with the greatest declines among infants younger than 1 year. Total estimated direct medical expenditures for chicken pox hospitalizations and ambulatory visits declined by 74 percent, from an average of $84.9 million in 1994 and 1995 to $22.1 million in 2002.
"The data in our study demonstrate the substantial success that the varicella vaccine program has shown since it was implemented 10 years ago. However, nationally representative data are needed to more accurately monitor the impact of the varicella vaccination program. The Council of State and Territorial Epidemiologists has recommended that states now begin to conduct case-based surveillance," the authors conclude.
(JAMA. 2005;294:797-802. Available pre-embargo to the media at www.jamamedia.org)
EDITORIAL: VARICELLA VACCINE, COST-EFFECTIVENESS ANALYSES, AND VACCINATION POLICY
In an accompanying editorial, Matthew M. Davis, M.D., M.A.P.P., of the University of Michigan, Ann Arbor, comments on the study by Zhou et al.
"...these findings do not conclusively confirm that childhood varicella vaccination is as cost-effective as originally anticipated, for several reasons. First, the cost of the vaccine has increased more than $10 per dose in inflation-adjusted terms since 1995 (the current public sector price per dose is $52.25), although an increase of this magnitude was not anticipated to change the cost-effectiveness dramatically. Second, the national varicella vaccine recommendation prompted states to measure and react to varicella as a reportable vaccine-preventable illness. The costs of such monitoring and of responding to outbreaks of varicella (e.g., in day care or school settings) may be substantial and were not included in the original analysis [in another study]."
"Third, and perhaps most important, there is great uncertainty about the extent to which parents and other adults experienced reductions in lost work time attributable to varicella. As with other childhood and adolescent vaccines that have recently been recommended (e.g., pneumococcal and meningococcal conjugate vaccines), indirect cost savings with varicella vaccine were expected to be larger than savings in direct medical costs."
"To maximize the benefits of vaccines for children and adults in the future, it is imperative to formally and openly consider how best to incorporate cost-effectiveness considerations into deliberations about vaccine recommendations, thereby acknowledging that health and economics cannot be teased apart. From the perspectives of patients, payers, clinicians, and public health officials, costs are just as much a part of vaccines as their benefits," Dr. Davis concludes.
(JAMA. 2005;294:845-846. 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, August 16, 2005
Media Advisory: To contact corresponding author Harlan M. Krumholz, M.D., S.M., call Karen Peart at 203-432-1326.
RECEIVING INITIAL TREATMENT FOR HEART ATTACK AT HOSPITAL DURING OFF-HOURS ASSOCIATED WITH POORER OUTCOMES
CHICAGO—Patients who arrive at a hospital during off-hours and on the weekend following a heart attack have longer times to the restoration of normal blood flow and a higher risk of death, according to a study in the August 17 issue of JAMA.
Reperfusion therapy (restoration of blood flow to an organ or tissue) with either fibrinolytic therapy
(medication for dissolving blood clots) or percutaneous coronary intervention (PCI; procedures such as angioplasty in which a catheter-guided balloon is used to open a narrowed coronary artery) reduces the risk of death for eligible ST-segment elevation myocardial infarction (STEMI; a certain finding on an
electrocardiogram following a heart attack) patients. The shorter the time from symptom onset to treatment, the greater the survival benefit with either therapy.
David J. Magid, M.D., M.P.H., of Kaiser Permanente, Denver, and colleagues examined the relationship between time of day and day of week and reperfusion treatment times for STEMI patients treated with fibrinolytic therapy or PCI. The authors write that understanding the reasons for variation in reperfusion treatment times by patient arrival period, and whether such variation is common to all hospitals and to both fibrinolytic therapy and PCI, could inform the design and targeting of interventions to improve timely reperfusion.
The study included 68,439 patients with STEMI treated with fibrinolytic therapy and 33,647 treated with PCI from 1999 through 2002. The researchers classified patient hospital arrival period into regular hours (weekdays, 7 a.m.-5 p.m.) and off-hours (weekdays 5 p.m.-7 a.m. and weekends).
The researchers found that most fibrinolytic therapy (67.9 percent) and PCI patients (54.2 percent) were treated during off-hours. Door-to-drug times (the time from arriving at the hospital to receiving blood-clot dissolving medications) were slightly longer during off-hours (34.3 minutes) than regular hours (33.2 minutes; difference, 1.0 minute). In contrast, door-to-balloon times (the time from arriving at the hospital to receiving PCI) were substantially longer during off-hours (116.1 minutes) than regular hours (94.8 minutes; difference, 21.3 minutes). A lower percentage of patients met guideline recommended times for door-to-balloon during off-hours (26 percent) than regular hours (47 percent). Door-to-balloon times exceeding 120 minutes occurred much more commonly during off-hours (42 percent) than regular hours (28 percent). Longer off-hours door-to-balloon times were primarily due to a longer interval between obtaining the electrocardiogram and patient arrival at the catheterization laboratory (off-hours 69.8 minutes vs. regular hours 49.1 minutes). This pattern was consistent across all hospital subgroups examined.
Patients arriving during off-hours had significantly higher adjusted in-hospital death rates than patients arriving during regular hours. This mortality difference was reduced by 43 percent when researchers adjusted for differences in reperfusion treatment times, suggesting that the higher off-hours mortality was due in part to longer reperfusion treatment times.
The researchers add that this study demonstrates that delays to PCI during off-hours are common to all types of hospitals, including high-volume PCI centers.
"Our study has implications for the delivery of reperfusion therapy during off-hours. Because delays to PCI can result in lower survival rates for STEMI patients, institutions providing PCI during off-hours should commit to doing so in a timely manner. One way to improve the timeliness of PCI during off-hours would be to provide onsite staffing of the cardiac catheterization laboratory around-the-clock. However, the clinical benefits of providing continuous in-house staffing of the cardiac catheterization laboratory must be weighed against the extra cost of providing such coverage," the researchers write.
"Another possible solution is to cross-train noncardiac catheterization laboratory staff to assist with PCI during off-hours. However, the benefits of cross-training staff may not be realized unless rapid access to interventional cardiologists is also available. Still another approach would be to regionalize interventional cardiac care, transporting off-hour patients to institutions with continuous cardiac catheterization laboratory staffing and rapid door-to-balloon times. However, this approach would only affect patients transported by emergency medical services and the faster door-to-balloon times at regional centers might be offset by prolonged transport times to these hospitals," the authors write.
(JAMA. 2005;294:803-812. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was supported by a grant from the 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, August 16, 2005
Media Advisory: To contact corresponding author John A. Kellum, M.D., call Jocelyn Uhl at 412-647-3555.
STUDY EXAMINES GLOBAL PREVALENCE OF KIDNEY FAILURE AMONG CRITICALLY ILL PATIENTS
CHICAGO—A multinational study has found that 5 to 6 percent of patients in intensive care units experience acute kidney failure, and about 60 percent of these patients die in the hospital, according to an article in the August 17 issue of JAMA.
The epidemiology and outcome of acute renal (kidney) failure (ARF) in critically ill patients in different regions of the world have not been well understood, according to background information in the article.
Shigehiko Uchino, M.D., of Austin Hospital, Melbourne, Australia, and colleagues conducted a study to determine the prevalence of ARF in intensive care unit (ICU) patients at 54 hospitals in 23 countries. The ICU patients were either treated with renal replacement therapy (RRT), such as dialysis, or fulfilled at least 1 of the predefined criteria for ARF from September 2000 to December 2001.
Of 29,269 critically ill patients admitted during the study period, 1,738 (5.7 percent) had ARF during their ICU stay, including 1,260 who were treated with RRT. The most common contributing factor to ARF was septic shock (47.5 percent). Approximately 30 percent of patients had preadmission renal dysfunction. The overall hospital death rate was 60.3 percent. Dialysis dependence at hospital discharge was 13.8 percent for survivors. Independent risk factors for hospital death included use of vasopressors (drugs that produce a rise in blood pressure), mechanical ventilation, septic shock, cardiogenic shock, and hepatorenal syndrome (kidney failure combined with severe liver disease).
"In summary, we have conducted a multinational, multicenter, prospective, epidemiological study of ARF that includes the largest and most representative sample of ICUs and ARF patients so far," the authors write. "This information may be helpful in the design of future international interventional trials, which would apply to worldwide practice, in regard to the statistical power and choice of appropriate outcome measures."
(JAMA. 2005;294:813-818. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by an unrestricted educational grant from the Austin Hospital Anaesthesia and Intensive Care Trust Fund.
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
CHICKEN POX VACCINE REDUCED HOSPITALIZATIONS AND DOCTOR VISITS - REDUCED ANNUAL HEALTH CARE SPENDING BY $63 MILLION
VIDEO:
Dr. Gotlieb examining baby boy
AUDIO:
DR. JAQUELIN GOTLIEB HAS BEEN A PEDIATRICIAN FOR ABOUT 30 YEARS. OVER THE LAST FEW YEARS, SHE’S NOTICED A CHANGE.
VIDEO:
SOT/FULL
@ :08
Super: Jaquelin Gotlieb, M.D.
Pediatrician
Runs :05
AUDIO:
"We are seeing much less chicken pox. We used to see it very frequently."
VIDEO:
B-ROLL
Babies (over one year of age) and children receiving vaccine
GFX/JAMA COVER
Babies (over one year of age) and children receiving vaccine
AUDIO:
THAT CHANGE IS BECAUSE OF THE CHICKEN POX VACCINE, ALSO CALLED VARICELLA VACCINE. A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, COMPARED CHICKEN POX-RELATED HEALTH CARE BEFORE AND AFTER 1995, WHEN THE VACCINE WAS INTRODUCED. .
VIDEO:
SOT/FULL
@ :27
Super: Abigail Shefer, M.D.
National Immunization Program, CDC
Runs :09
AUDIO:
"Chicken pox vaccine is working. From 1994 to 2002, the rate of hospitalization decreased 88%. The rate of medical visits decreased almost 60%."
VIDEO:
B-ROLL
Dr. Shefer going over data with colleague
1-year old baby
Child
Teens
Doctor examining child
AUDIO:
DR. ABIGAIL SHEFER (SHEF-er,) AND HER COLLEAGUES AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION’S NATIONAL IMMUNIZATION PROGRAM, TRACKED THE HEALTH RECORDS OF MORE THAN 2 MILLION BABIES, CHILDREN, TEENS AND ADULTS. THEY FOUND THAT THOSE DECREASES IN HOSPITALIZATIONS AND MEDICAL VISITS SAVED A LOT OF MONEY.
VIDEO:
SOT/FULL
Abigail Shefer, M.D.
National Immunization Program, CDC
Runs :05
AUDIO:
"Direct medical care expenditures decreased almost 75%, from 85 million to 22 million."
VIDEO:
FULL SCREEN GRAPHIC
Title: Chicken pox-related health care spending
Reduction = $63 million
B-ROLL
Mother feeding infant in high chair
Different infant with big sister (5-year old)
AUDIO:
SHE’S TALKING ABOUT A REDUCTION OF 63 MILLION DOLLARS. AND THAT’S NOT ALL THIS STUDY REVEALED. YOU MUST BE AT LEAST A YEAR OLD TO GET THE CHICKEN POX VACCINE, BUT INFANTS SAW THE GREATEST BENEFIT FROM THE VACCINE. FEWER OF THEM GOT THE CHICKEN POX, WHICH CAN BE DEADLY IN INFANTS.
VIDEO:
SOT/FULL
Abigail Shefer, M.D.
National Immunization Program, CDC
Runs :15
AUDIO:
"Even though they’re not able to receive the vaccine because they’re too young, they benefited because the rates declined so greatly in children, adolescents and adults and therefore there was less disease circulating for infants to be exposed to."
VIDEO:
B-ROLL
More children being vaccinated
Toddler boy kissing his infant sister
Dr. Gotlieb with Mom holding baby
AUDIO:
TEENS AND ADULTS BENEFITED FOR THE SAME REASON. KIDS GOT VACCINATED, SO THEY DIDN’T GET CHICKEN POX, SO THEY DIDN’T PASS THE DISEASE TO OTHERS. DR. GOTLIEB SAYS THERE ARE MANY BENEFITS TO THE VACCINE.
VIDEO:
SOT/FULL
Jaquelin Gotlieb, M.D.
Pediatrician
Runs :12
AUDIO:
"Not only are we seeing less direct medical costs, we’re seeing a lot less sick children and we’re seeing a lot less indirect costs of people having to miss work and children having to miss school."
VIDEO:
B-ROLL
Kids stepping off school bus
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
