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, November 8, 2005)
JAMA NEWS RELEASES
CHILDREN OVERPRESCRIBED ANTIBIOTICS FOR SORE THROAT
CLINICAL DECISION SYSTEM HELPS REDUCE INAPPROPRIATE ANTIMICROBIAL PRESCRIBING
NO LINK FOUND BETWEEN CAFFEINE INTAKE AND DEVELOPMENT OF HYPERTENSION IN WOMEN
ADEQUATE VITAMIN D STATUS APPEARS MORE IMPORTANT THAN HIGH CALCIUM INTAKE FOR MAINTAINING CALCIUM METABOLISM
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
DRINKING COFFEE DOES NOT INCREASE WOMEN’S RISK OF HIGH BLOOD PRESSURE – BUT DRINKING COLA MAY
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TV Note: This week's JAMA video news release is on habitual caffeine intake and the risk of hypertension in women. The release will be fed Tuesday, November 8, 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, November 8, 2005
Media Advisory: To contact Jeffrey A. Linder, M.D., M.P.H., call Melanie Franco at 617-534-1605.
CHILDREN OVERPRESCRIBED ANTIBIOTICS FOR SORE THROAT
CHICAGO—Physicians prescribe antibiotics for more than half of children with sore throat, exceeding the expected prevalence of strep throat, and used nonrecommended antibiotics for 27 percent of children who received an antibiotic prescription, according to a study in the November 9 issue of JAMA.
Pharyngitis (inflammation of the throat) accounts for 6 percent of visits by children to family medicine physicians and pediatricians, according to background information in the article. The most common manifestation of acute pharyngitis is sore throat. The main bacterial cause of sore throat and the only common cause of sore throat warranting antibiotic treatment is group A beta-hemolytic streptococci (GABHS). GABHS are cultured from 15 percent to 36 percent of children with sore throat. To improve diagnostic accuracy and reduce unnecessary antibiotic treatment, it is recommended that a GABHS test be conducted prior to treating children with an antibiotic. Penicillin is the recommended antibiotic, but acceptable alternatives include amoxicillin, erythromycin (for penicillin-allergic patients), and first-generation cephalosporins.
Jeffrey A. Linder, M.D., M.P.H., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the change in the rate and type of antibiotics prescribed to children with a chief complaint of sore throat, and the frequency of GABHS testing.
The researchers used data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 1995 to 2003. The study included an analysis of visits by children aged 3 to 17 years with sore throat to office-based physicians, hospital outpatient departments, and emergency departments (n = 4,158), and of a subset of visits with GABHS testing data (n = 2,797).
The researchers found that physicians prescribed antibiotics in 53 percent of an estimated 7.3 million annual visits for sore throat and nonrecommended antibiotics to 27 percent of children who received an antibiotic. Antibiotic prescribing decreased from 66 percent of visits in 1995 to 54 percent of visits in 2003. This decrease was attributable to a decrease in the prescribing of recommended antibiotics (49 percent to 38 percent). Physicians performed a GABHS test in 53 percent of visits and in 51 percent of visits at which an antibiotic was prescribed. GABHS testing was not associated with a lower antibiotic prescribing rate overall (48 percent tested vs. 51 percent not tested), but testing was associated with a lower antibiotic prescribing rate for children with diagnosis codes for pharyngitis, tonsillitis, and streptococcal sore throat (57 percent tested vs. 73 percent not tested).
"In conclusion, we found that physicians prescribed antibiotics less frequently over time to children with sore throat. However, the overall antibiotic prescribing rate continues to exceed the expected prevalence of GABHS, and physicians continue to select unnecessarily broad-spectrum antibiotics. Unnecessary antibiotic prescriptions are not benign: they increase the prevalence of antibiotic-resistant bacteria, expose patients to adverse drug events, and increase costs. Perhaps unique among upper respiratory tract infections, clinicians have good, objective criteria in the form of GABHS testing to guide the antibiotic treatment of children with sore throat. Limiting antibiotic prescribing to children with a positive GABHS test result is a feasible goal for primary care physicians and an important step toward judicious use of antibiotics overall," the authors write.
(JAMA. 2005;294:2315-2322. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Agency for Healthcare Research and Quality through a Career Development Award to Dr. Linder. Co-author Grace M. Lee, M.D., M.P.H., is supported by an Agency for Healthcare Research and Quality Career Development Award.
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, November 8, 2005
Media Advisory: To contact Matthew H. Samore, M.D., call Chantelle Turner at 801-581-5717. To contact editorial author J. Todd Weber, M.D., call Dave Daigele at 404-639-3286.
CLINICAL DECISION SYSTEM HELPS REDUCE INAPPROPRIATE ANTIMICROBIAL PRESCRIBING
CHICAGO—A clinical decision support system intervention reduced the overall use of antimicrobials for respiratory tract infections such as colds, bronchitis and sinusitis, according to a study in the November 9 issue of JAMA.
Antimicrobial resistance is a serious public threat that is exacerbated by the gradual withdrawal of the pharmaceutical industry from new antimicrobial agent development, according to background information in the article. Overuse of antimicrobial agents fosters the spread of antimicrobial-resistant organisms. Despite recent trends that demonstrate reduced outpatient use of antimicrobial agents, prescribing continues to significantly exceed prudent levels. Approximately 50 percent of courses of ambulatory antimicrobial drugs are prescribed for patients with viral respiratory infections and therefore, are not clinically indicated.
Matthew H. Samore, M.D., of the University of Utah, Salt Lake City, and colleagues evaluated the effectiveness of a direct intervention with primary care clinicians that was used to reduce the rate of inappropriate prescribing of antimicrobial drugs for acute respiratory infections. The intervention, the clinical decision support system (CDSS), incorporated stand-alone decision support tools on paper and a handheld personal digital assistant (PDA) to guide diagnosis and management of the acute respiratory tract infection. The researchers measured the added value of the CDSS when coupled with a community intervention.
The PDA-based CDSS generated diagnostic and therapeutic recommendations on the basis of patient-specific information that was input about the suspected diagnosis, such as the presence or absence of specific symptoms and signs. Therapeutic recommendations included over-the-counter medications for symptom control as well as prescription antimicrobials. In the study, antimicrobial agents were grouped into 4 classes: penicillins, macrolides, cephalosporins, and other.
The randomized trial included 407,460 inhabitants and 334 primary care clinicians in 12 rural communities in Utah and Idaho and a third group of 6 communities that served as nonstudy controls. The pre-intervention period was January to December 2001 and the postintervention period was January 2002 to September 2003. Six communities received a community intervention alone and 6 communities received community intervention plus CDSS that were targeted toward primary care clinicians. Community-wide antimicrobial usage was assessed using retail pharmacy data. Diagnosis-specific antimicrobial use was compared by chart review.
Within CDSS communities, 71 percent of primary care clinicians participated in the use of CDSS. The researchers found that during the second-intervention year, prescribing rates in CDSS communities decreased 10 percent from baseline, whereas in the community intervention–alone communities and nonstudy communities, prescribing rates in 2003 increased by 1 percent and 6 percent, respectively. The prescribing rate decreased from 84.1 to 75.3 per 100 person-years in the CDSS group vs. 84.3 to 85.2 in community intervention alone, and remained stable in the other communities. A total of 13,081 acute respiratory infection visits were documented for this study. The relative decrease in antimicrobial prescribing for visits in the antibiotics "never-indicated" category during the post-intervention period was 32 percent in CDSS communities and 5 percent in community intervention-alone communities. Use of macrolides decreased significantly in CDSS communities but not in community intervention-alone communities.
"This trial demonstrated the feasibility, uptake, and benefit of stand-alone, portable CDSS tools for acute respiratory infections in rural primary care settings. The CDSS decreased unnecessary use of antimicrobial agents for viral respiratory tract infections and improved antimicrobial agent selection," the authors write.
"An unresolved question is whether the modest decrease in total antimicrobial prescriptions and more substantial reduction in macrolide use induced by the CDSS intervention was sufficient to lessen selection of resistant pneumococci and other bacteria in community populations. Decreased prevalence of resistant organisms may not necessarily accompany lowered antimicrobial consumption, in part because resistant organisms have an ability to develop compensatory mutations that ameliorate the fitness costs of resistance. More potent interventions that sustain greater improvements in antimicrobial use may be needed to adequately control antimicrobial resistance," the researchers conclude.
(JAMA. 2005;294:2305-2314. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
EDITORIAL: APPROPRIATE USE OF ANTIMICROBIAL DRUGS - A BETTER PRESCRIPTION NEEDED
In an accompanying editorial, J. Todd Weber, M.D., of the Centers for Disease Control and Prevention, Atlanta, comments on the studies in this week’s JAMA on antimicrobial drugs.
"All interventions for improving appropriate use of antimicrobial drugs must be introduced and promoted in the context of efforts to improve awareness among the public and to further educate prescribers. Additional interventions can include formulary restrictions, practice measures such as those currently used and planned for the Health Plan Employer Data and Information Set, clinical decision support systems, and other measures indirectly related to prescribing. These interventions, as well as algorithms and guidelines to improve antimicrobial use, must be transparently evidence-based. Such interventions that improve quality of care for individual patients save time, reduce prescribing errors, and reduce costs and are those most likely to be acceptable, effective, and sustainable."
"Increased use of an electronic health record may serve as the framework for some of these practice changes. The electronic health record also may help answer the need for better, more universal, readily available data for designing and evaluating interventions that include patient-linked microbiological testing and results, diagnoses, and prescriptions. Surveillance systems under development, such as the National Healthcare Safety Network, may also provide the data required for better study of antimicrobial use and resistance," Dr. Weber writes.
(JAMA. 2005;294:2354-2356. 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, November 8, 2005
Media Advisory: To contact Wolfgang C. Winkelmayer, M.D., Sc.D., call Amy Dayton Smith at 617-534-1603.
NO LINK FOUND BETWEEN CAFFEINE INTAKE AND DEVELOPMENT OF HYPERTENSION IN WOMEN
CHICAGO—Habitual coffee drinking is not associated with an increased risk of hypertension in women, although an association was found with the consumption of sugared or diet colas, according to a study in the November 9 issue of JAMA.
Approximately 50 million people in the United States have hypertension, and the prevalence is increasing, according to background information in the article. Hypertension is a major risk factor for coronary heart disease, stroke, and congestive heart failure. Therefore, even small reductions in the prevalence of hypertension could have a potentially large public health and financial impact. Several previous studies have indicated a possible association between caffeine intake and the risk of hypertension. Short-term studies have demonstrated that caffeine intake acutely increases blood pressure, but over time, weakening of this effect does occur. A long-term effect of caffeine intake on the risk of developing hypertension would be of substantial public health importance given the widespread consumption of beverages containing caffeine, but currently, studies of this association are scarce.
Wolfgang C. Winkelmayer, M.D., Sc.D., of Brigham and Women’s Hospital and the Harvard School of Public Health, Boston, and colleagues conducted a study to determine whether caffeine intake or consumption of certain caffeine-containing beverages is associated with an increased risk of incident hypertension in women. The researchers analyzed data from the Nurses’ Health Studies (NHSs) I and II of 155,594 U.S. women free from physician-diagnosed hypertension, who were followed-up over 12 years (1990-1991 to 2002-2003). Caffeine intake and possible confounders were ascertained from regularly administered questionnaires.
Over the 12 years, 19,541 incident cases of physician-diagnosed hypertension were reported in NHS I and 13,536 in NHS II. In both cohorts, no linear association between caffeine consumption and risk of incident hypertension was observed after multivariate adjustment. When studying individual classes of caffeinated beverages, habitual coffee consumption was not associated with increased risk of hypertension. By contrast, consumption of cola beverages was associated with an increased risk of hypertension, independent of whether it was sugared or diet cola.
"In this study with more than 1.4 million person-years of follow-up [the number of women in the study times the number of years of follow-up per woman], the relevant exposures and outcomes have been found valid and accurate, and coffee intake was updated to reflect changes in individual behavior. We found strong evidence to refute speculation that coffee consumption is associated with an increased risk of hypertension in women," the authors write.
Concerning the link found between colas and hypertension, the researchers write: "… we speculate that it is not caffeine but perhaps some other compound contained in soda-type soft drinks that may be responsible for the increased risk in hypertension. If these associations are causal, they may have considerable impact on public health."
(JAMA. 2005;294:2330-2335. 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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Embargoed for Release: 3 p.m. CT, Tuesday, November 8, 2005
Media Advisory: To contact corresponding author Gunnar Sigurdsson, M.D., Ph.D., email: gunnars{at}landspitali.is.
ADEQUATE VITAMIN D STATUS APPEARS MORE IMPORTANT THAN HIGH CALCIUM INTAKE FOR MAINTAINING CALCIUM METABOLISM
CHICAGO—Calcium intake levels of more than 800 mg/day may be unnecessary for maintaining calcium metabolism if vitamin D status is adequate, according to a study in the November 9 issue of JAMA.
The importance of adequate vitamin D status for optimum bone health has received increased recognition in recent years, with higher recommended intake levels being proposed by some investigators, according to background information in the article. The ideal intake is not known, and different criteria have been proposed for estimating population requirements. Serum 25-hydroxyvitamin D has been the generally accepted indicator of vitamin D status, but no universal consensus has been reached regarding which serum values constitute sufficiency. An inverse relationship between serum 25-hydroxyvitamin D and serum parathyroid hormone (PTH) is well established. Parathyroid hormone is a major hormone maintaining normal serum concentrations of calcium and phosphate and is itself regulated through levels of calcitriol and serum calcium. An insufficiency of vitamin D or calcium is generally associated with an increase in PTH.
Laufey Steingrimsdottir, Ph.D., of Landspitali-University Hospital, Reykjavik, Iceland, and colleagues conducted a study to determine the importance of high calcium intake and serum 25-hydroxyvitamin D for calcium homeostasis (metabolic equilibrium) in healthy adults, as determined by serum intact PTH.
The study included 2,310 healthy Icelandic adults who were divided equally into 3 age groups (30-45 years, 50-65 years, or 70-85 years) and recruited from February 2001 to January 2003. They were administered a semi-quantitative food frequency questionnaire, which assessed vitamin D and calcium intake. Participants were further divided into groups according to calcium intake (less than 800 mg/d, 800-1200 mg/d, and greater than1200 mg/d) and serum 25-hydroxyvitamin D level (less than 10 ng/mL, 10-18 ng/mL, and greater than 18 ng/mL). A total of 944 participants completed the dietary questionnaire.
The researchers found that after adjusting for relevant factors, serum intact PTH was lowest in the group with a serum 25-hydroxyvitamin D level of more than 18 ng/mL but highest in the group with a serum 25-hydroxyvitamin D level of less than 10 ng/mL. At the low serum 25-hydroxyvitamin D level (less than 10 ng/mL), calcium intake of less than 800 mg/d vs. more than 1200 mg/d was significantly associated with higher serum PTH; and at a calcium intake of more than 1200 mg/d, there was a significant difference between the lowest and highest vitamin D groups.
"The significance of our study was demonstrated by the strong negative association between sufficient serum levels of 25-hydroxyvitamin D and PTH, with calcium intake varying from less than 800 mg/d to more than 1200 mg/d. Our results suggest that vitamin D sufficiency can ensure ideal serum PTH values even when the calcium intake level is less than 800 mg/d, while high calcium intake (greater than 1200 mg/d) is not sufficient to maintain ideal serum PTH, as long as vitamin D status is insufficient," the authors write.
"Although a cross-sectional study such as our study is not sufficient to demonstrate causality, the association between vitamin D status, calcium intake, and the interaction between these 2 with serum PTH levels is a strong indication of the relative importance of these nutrients," the researchers write. "Although ideal intakes of these 2 nutrients need to be further defined in more elaborate studies, there is already sufficient evidence from numerous studies for physicians and general practitioners to emphasize to a much greater extent the importance of vitamin D status and recommend vitamin D supplements for the general public, when sun exposure and dietary sources are insufficient."
"In conclusion, our study suggests that vitamin D sufficiency may be more important than high calcium intake in maintaining desired values of serum PTH. Vitamin D may have a calcium sparing effect and as long as vitamin D status is ensured, calcium intake levels of more than 800 mg/d may be unnecessary for maintaining calcium metabolism. Vitamin D supplements are necessary to ensure adequate vitamin D status for most of the year in northern climates."
(JAMA. 2005;294:2336-2341. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note:This study was supported by a grant from the Science Fund of St. Josephs Hospital, Landakoti, and the University Hospital, Reykjavik, Iceland.
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
DRINKING COFFEE DOES NOT INCREASE WOMEN’S RISK OF HIGH BLOOD PRESSURE – BUT DRINKING COLA MAY
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YOU MIGHT THINK CAFFEINATED COFFEE WOULD INCREASE YOUR BLOOD PRESSURE. NOT SO, ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
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Super: Wolfgang Winkelmayer, M.D., Sc.D.
Brigham and Women’s Hospital
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"Coffee drinking was not at all associated with a greater risk of high blood pressure. If anything, coffee drinking was associated with a preventive effect in that women who drank more coffee were less likely to have high blood pressure."
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DR. WOLFGANG WINKELMAYER (wink-el-my-er) WAS PART OF THE 12-YEAR STUDY OF ABOUT 150-THOUSAND WOMEN. THE RESEARCHERS, FROM BRIGHAM AND WOMEN’S HOSPITAL IN BOSTON AND OTHER INSTITUTIONS, EXPECTED TO FIND THAT CAFFEINATED COFFEE INCREASED THE RISK OF HIGH BLOOD PRESSURE.
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Wolfgang Winkelmayer, M.D., Sc.D.
Brigham and Women’s Hospital
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"It was absolutely surprising to us that women who drank 6 or more cups of coffee a day, that even those women did not have an increased risk of high blood pressure."
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BUT FOR WOMEN WHO DRANK CAFFEINATED COLA, THE NEWS WAS NOT SO GOOD.
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Wolfgang Winkelmayer, M.D., Sc.D.
Brigham and Women’s Hospital
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"We found that drinking soda beverages that contained caffeine, regular cola or diet cola, was associated with a greater risk of high blood pressure."
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Title: Cola linked to high blood pressure
Women
Average age - 36
Diet cola – increased risk 16%
Regular cola- increased risk 28%
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Women
Average age – 55
Diet cola – increased risk 19%
Regular cola- increased risk 44%
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Backtime Dr. Winkelmayer
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IN FACT, COMPARED TO WOMEN WHO DRANK LESS THAN TWELVE OUNCES OF COLA A DAY, YOUNGER WOMEN WHO DRANK FORTY-EIGHT OUNCES A DAY, ABOUT FOUR CANS, SAW THEIR RISK OF HIGH BLOOD PRESSURE GO UP SIXTEEN PERCENT FOR DIET COLA, TWENTY-EIGHT PERCENT FOR REGULAR. FOR OLDER WOMEN, THE RISKS WENT UP NINETEEN PERCENT AND FORTY-FOUR PERCENT. STILL, DR. WINKELMAYER SAYS IT’S TOO SOON TO BLAME COLA FOR HIGH BLOOD PRESSURE.
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Wolfgang Winkelmayer, M.D., Sc.D.
Brigham and Women’s Hospital
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"I would not jump to any conclusions at this point. I really believe that more research is necessary to solidify these findings."
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BUT HE SAYS HIS FINDINGS ABOUT CAFFEINATED COFFEE ARE CLEAR, AND ARE GOOD NEWS FOR WOMEN WORRIED ABOUT HIGH BLOOD PRESSURE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
