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: 3:00 p.m. CT, Tuesday, January 31, 2006)
JAMA NEWS RELEASES
WOMEN WITH MAJOR DEPRESSION AT RISK OF RELAPSE DURING PREGNANCY
IMPLEMENTATION OF BLOOD SAFETY PROGRAM IN SOUTH AFRICA ASSOCIATED WITH DECLINE IN HIV-1 IN BLOOD DONATIONS
PRELIMINARY RESEARCH SHOWS PROMISE FOR USING STEM CELL TRANSPLANTATION TO TREAT PATIENTS WITH SEVERE LUPUS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
CONTRARY TO POPULAR BELIEF, PREGNANCY DOES NOT PROTECT AGAINST DEPRESSION
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 risk of depression relapse for women during pregnancy. The release will be fed Tuesday, January 31, 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: 3:00 p.m. CT, Tuesday, January 31, 2006
Media Advisory: To contact Lee S. Cohen, M.D., call Sue McGreevey at 617-724-2764.
WOMEN WITH MAJOR DEPRESSION AT RISK OF RELAPSE DURING PREGNANCY
CHICAGO—Contrary to a common belief that the hormonal changes associated with pregnancy provide a protective effect against depression, women with major depression who discontinue antidepressant medication during pregnancy are at risk of relapse, according to a study in the February 1 issue of JAMA.
Lee S. Cohen, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues conducted a study to determine the risk of relapse in pregnant women with major depression who discontinued or who attempted to discontinue antidepressant medication close to conception compared with those who maintained treatment with these medications. The study included a total of 201 pregnant women who enrolled between March 1999 and April 2003 at 3 centers with specific expertise in the treatment of psychiatric illness during pregnancy. The participants had a history of major depression prior to pregnancy, were less than 16 weeks’ gestation, and were currently or recently (less than 12 weeks prior to last menstrual period) receiving antidepressant medication.
The researchers found that 43 percent of women in the sample relapsed during pregnancy, and half of those relapsed during the first trimester. Among women who maintained their medication throughout the pregnancy, 26 percent relapsed compared with 68 percent of those who discontinued their medication.
“Given the prevalence of depression in reproductive age women, the prevalence of antidepressant use in this population and the frequency of unplanned pregnancy, the ability to inform patients about risk of depressive relapse if either discontinuation or maintenance of treatment is pursued as a clinical course has significant implications,” the authors write.
“With greater awareness and increasing treatment of depression in the community, growing numbers of women may face a clinical decision regarding use of antidepressant medication during pregnancy. Navigating this clinical course can be facilitated by the accurate delineation of the relative risks of prenatal exposure to medication on the one hand and the risk of relapse of psychiatric disorder on the other. Quantification of these risks affords clinicians the opportunity to make collaborative treatment decisions consistent with individual needs and wishes. Such information can also help to refine treatment guidelines for women with a history of depression who are planning to conceive or who experience mood disorders during pregnancy,” the researchers conclude.
(JAMA. 2006;295:499-507. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was funded by the National Institute of Mental Health. Co-author D. Jeffrey Newport, M.D., has served on the speakers bureaus for GlaxoSmithKline, Lilly, and Pfizer. Co-author Zachary N. Stowe, M.D., has served on the speakers bureaus for GlaxoSmithKline, Wyeth, and Pfizer; has received grants from GlaxoSmithKline and Wyeth; and has served on advisory boards for Bristol-Myers Squibb and GlaxoSmithKline. None of the other authors reported disclosures.
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: 3:00 p.m. CT, Tuesday, January 31, 2006
Media Advisory: To contact Anthon du P. Heyns, D.Sc., M.D., email: aheyns{at}inl.sanbs.org.za. To contact editorial co-author Linda-Gail Bekker, M.B.Ch.B., F.C.P.(SA), Ph.D., email: linda-gail.bekker{at}hiv-research.org.za.
IMPLEMENTATION OF BLOOD SAFETY PROGRAM IN SOUTH AFRICA ASSOCIATED WITH DECLINE IN HIV-1 IN BLOOD DONATIONS
CHICAGO—A blood safety program in South Africa that included closing donor clinics in areas of high HIV prevalence is associated with a decrease in the prevalence of HIV in donated blood, according to study in the February 1 issue of JAMA.
South Africa is in the midst of an escalating human immunodeficiency virus (HIV)–AIDS pandemic, with an estimated 5.3 million people and 11.4 percent of the overall population infected, according to background information in the article. The South African National Blood Service (SANBS) collects more than 700,000 units of whole blood each year using internationally endorsed principles of voluntary donation, screening, and testing. The World Health Organization (WHO) estimates that 5 percent to 10 percent of HIV/AIDS cases continue to be acquired from infected blood transfusions. An analysis of South African donations in 1999 estimated the risk of HIV-1 infection at 3.4 per 100,000 donations. These data necessitated the development of a program to minimize this risk.
Anthon du P. Heyns, D.Sc., M.D., of the South African National Blood Service, Weltevreden Park, South Africa, and colleagues examined the prevalence of HIV-1 in blood donations before and after the implementation of new policies and estimated the residual risk for all blood donations following full program implementation. The researchers compared the prevalence of HIV-1 in blood donations collected from 1999 through 2000 with blood donations collected from 2001 through 2002 and estimated the incidence of HIV-1 in first-time donations and the residual risk for all donations in 2001-2002. All blood donors in the Inland region of the South African National Blood Service were analyzed.
The new policies included closing donor clinics in areas where HIV prevalence is high and programs targeting the youth and promoting repeat donation were initiated. Risk behavior education programs were developed for staff and donors. Structured donor interviews with direct oral questioning were institutionalized to ensure understanding of the self-exclusion questionnaire.
After implementation of the new policies, prevalence of HIV-1 in blood donations declined 50 percent, from 0.17 percent in 1999-2000 to 0.08 percent in 2001-2002 with a reduction seen in most demographic groups. This decrease was attributable to a reduction in the proportion of intermediate (4.9 percent to 3.3 percent) and high-risk (2.6 percent to 1.7 percent) donations and decreased prevalence in these categories. The prevalence of HIV-1 in first-time donors decreased by 45 percent. Donations from the majority black population declined from 6.6 percent to 4.2 percent.
“In the long term, we believe that education of blood donors will be a key factor for ongoing blood safety. There is a need for a structured program that is culturally attuned and presented in the multiple languages in common use. SANBS has been awarded funding under the President’s Emergency Plan for AIDS Relief to work with the Centers for Disease Control and Prevention, the American Association of Blood Banks and the American Red Cross to this end. It will be important to link this initiative to a broader national HIV/AIDS program and to promote blood donation as part of a safe lifestyle to prevent the spread of HIV through blood transfusions and high risk behaviors,” the authors conclude.
(JAMA. 2006;295:519-526. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For information on funding/support and financial disclosures, please see the JAMA article.
EDITORIAL: BLOOD SAFETY — AT WHAT COST?
In an accompanying editorial, Linda-Gail Bekker, M.B.Ch.B., F.C.P.(SA), Ph.D., and Robin Wood, B.Sc., B.M., M.M.Ed., F.C.P.(SA), from the University of Cape Town, South Africa, discuss the consequences of new policies on blood safety in South Africa.
“This crisis in South Africa highlights several ethical issues: the medical stigmatization of population groups by excluding them from the blood donor pool; the use of race in medical decision-making; and the relationship between public health medicine and society.”
“A further aspect highlighted by this controversy is the tendency of public health medicine to ignore the societal roots of poor health in favor of medical interventions, which operate further downstream. For example, it is easier to use more sophisticated screening technologies than address the underlying social inequalities,” they write.
“The future of the South African National Blood Service will depend on recruitment of future generations of safe donors. A national program, ‘Club 25’ encourages high school graduates aged 18 to 25 years to establish a donor culture, live a healthful lifestyle, and ensure safe blood for transfusion. Initiatives such as this program attempt to address both ongoing downstream safety of blood together with upstream health promotion, thereby addressing blood safety at a social level. Health professionals are learning that promoting and protecting human rights may be essential for promoting and protecting health.”
(JAMA. 2006;295:557-558. 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: 3:00 p.m. CT, Tuesday, January 31, 2006
Media Advisory: To contact Richard K. Burt, M.D., call Elizabeth Crown at 312-503-8928.
To contact editorial co-author Michelle Petri, M.D., M.P.H., call Eric Vohr at 410-955-8665.
PRELIMINARY RESEARCH SHOWS PROMISE FOR USING STEM CELL TRANSPLANTATION TO TREAT PATIENTS WITH SEVERE LUPUS
CHICAGO—About half of patients with severe lupus that was refractory to standard treatment and who underwent autologous stem cell transplantation to improve their immune system have substantial improvement in disease activity after several years, according to preliminary research published in the February 1 issue of JAMA.
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease that, despite advances in immunosuppressive medical therapies, continues to cause significant illness and death among patients with active disease, according to background information in the article. A more recent treatment is autologous hematopoietic stem cell transplantation (HSCT), in which stem cells from the patient are mobilized and re-infused into that patient to make new immune cells. HSCT includes eliminating defective lymphocytes (type of white blood cell involved in the immune system), often through chemotherapy, followed by infusion of hematopoietic stem cells (HSCs).
Richard K. Burt, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and colleagues conducted a study to determine whether HSCT could be performed safely in patients with SLE that has been resistant to other therapies, and whether there is sufficient evidence of efficacy to justify a definitive randomized trial. The study included 50 patients who were enrolled from April 1997 through January 2005.
The researchers found that of the 48 patients who underwent HSCT (2 patients died before transplantation), with an average followup of about 2.5 years, the overall 5-year survival was 84 percent. The probability of disease-free survival at 5 years was 50 percent. The longest continuous duration of remission has been 7.5 years. Treatment-related death was 2 percent (1/50). By intention to treat, treatment-related death was 4 percent (2/50).
“This trial provides the justification for a randomized study that compares autologous HSCT with continued standard of care. Through randomization, a cost-benefit analysis of HSCT may be undertaken. Patients with [treatment-resistant] and active lupus involving multiple organ systems despite a relatively young age traditionally have a high disease-related mortality rate. Continuing failing therapy for such patients is problematic but necessary to confirm that the increased acute risk of HSCT would be offset by better disease control and improved long-term survival, especially because the standard of care for lupus is constantly changing with the introduction of newer therapeutic agents,” the authors conclude.
(JAMA. 2006;295:527-535. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The authors wish to thank the BraveWings Foundation and Ginger’s Tomorrow Foundation for financial and patient support.
EDITORIAL: HIGH-DOSE CYCLOPHOSPHAMIDE AND STEM CELL TRANSPLANTATION FOR REFRACTORY SYSTEMIC LUPUS ERYTHEMATOSUS
In an accompanying editorial, Michelle Petri, M.D., M.P.H., and Robert Brodsky, M.D., of the Johns Hopkins University School of Medicine, Baltimore, comment on the study on treating lupus with stem cell transplantation.
“The original hope of stem cell transplantation was ‘going for the cure’ in patients with severe lupus. The remission rates reported with use of high-dose cyclophosphamide with stem cell transplantation, as reported by Burt et al, or without autologous stem cells, do not necessarily represent ‘cure’. Many patients continue to have lupus autoantibodies and with long-term follow-up, some patients with initial complete remissions will have late relapses. However, in these studies therapy was given as a ‘salvage regimen’ to patients with lupus who had failed or were [resistant to treatment] to multiple other therapies. Thus, as in the report by Burt et al the therapy offered substantial benefit–with either partial or complete response–to the majority of patients,” they write. “Whether this approach represents a definitive advance over more conventional immunosuppressive therapies will need to be answered in randomized controlled trials.”
(JAMA. 2006;295:559-560. 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
CONTRARY TO POPULAR BELIEF, PREGNANCY DOES NOT PROTECT AGAINST DEPRESSION
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Lisa folding laundry
Lisa putting away toys
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LISA KIRSHENBAUM HAS SUFFERED FROM DEPRESSION FOR TWENTY YEARS. ANTIDEPRESSANTS REALLY HELP HER. BUT WHEN SHE GOT PREGNANT FIVE YEARS AGO, SHE TOOK HER PSYCHIATRIST’S ADVICE.
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Suffers from depression
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“He had given me information that you know, I needed to go off all my medication and that pregnancy just created a natural high and that your body just adjusted and there was no risk really of depression.”
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Lisa putting away toy
Pharmacist counting antidepressant pills (no brands showing)
Dr. Cohen walking down hall
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BUT HER DEPRESSION CAME BACK, SEVERELY. SHE ENDED UP MISCARRYING. WHEN SHE GOT PREGNANT AGAIN, SHE STAYED ON HER ANTIDEPRESSANTS, UNDER THE WATCHFUL EYE OF DR. LEE COHEN, WHO HAS CO-AUTHORED A NEW STUDY ABOUT DEPRESSION AND PREGNANCY.
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Super: Lee Cohen, M.D.
Massachusetts General Hospital
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“We looked at women during pregnancy with histories of depression who were on antidepressants and who chose either to continue or to discontinue those antidepressants during pregnancy.”
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Exterior of Mass General
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DR. COHEN AND COLLEAGUES AT MASSACHUSETTS GENERAL HOSPITAL AND THREE OTHER INSTITUTIONS TRACKED THESE WOMEN, ABOUT TWO-HUNDRED OF THEM, THROUGH THEIR PREGNANCIES. THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
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Lee Cohen, M.D.
Massachusetts General Hospital
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“We found that patients who stopped their antidepressant during pregnancy were five times more likely to have return of depressive symptoms than those patients who had decided to continue their antidepressant during pregnancy.”
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Antidepressant pills (no brands showing)
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THAT’S ESSENTIALLY THE SAME RATE OF DEPRESSION THAT WOMEN WHO ARE NOT PREGNANT SUFFER WHEN THEY GO OFF THEIR ANTIDEPRESSANTS. SO...
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Lee Cohen, M.D.
Massachusetts General Hospital
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“Counter to what we may have believed or been told in the past, it does appear from these data that pregnancy does not protect women against depression during pregnancy.”
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Lisa making little girl’s bed
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LISA CAN ATTEST TO THAT. SHE ULTIMATELY GAVE BIRTH TO A HEALTHY GIRL, NOW TWO-YEARS OLD, AND HAS THIS ADVICE FOR OTHER WOMEN WHO SUFFER FROM DEPRESSION.
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Lisa Kirshenbaum
Suffers from depression
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“I think they need to seek expert advice on what they should do on an individual basis. I don’t advocate for medication, I advocate for expert advice before making decisions.”
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Lisa cleaning up toys
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SHE SAYS WITHOUT THAT ADVICE, SHE WOULDN’T HAVE HER DAUGHTER. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
