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, February 28, 2006)
JAMA NEWS RELEASES
A STEM CELL MOBILIZATION THERAPY APPEARS TO BE INEFFECTIVE IN REPAIRING DAMAGE CAUSED BY HEART ATTACK
COMBAT DUTY IN IRAQ LINKED WITH HIGH USE OF MENTAL HEALTH SERVICES
ATOMIC BOMB SURVIVORS WHO HAD HIGHER RADIATION EXPOSURE SHOW INCREASED INCIDENCE OF THYROID DISEASES
OVERACTIVE THYROID ASSOCIATED WITH DEVELOPMENT OF ABNORMAL HEART RHYTHM, BUT NOT OTHER CARDIOVASCULAR PROBLEMS
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
ONE-THIRD OF SOLDIERS AND MARINES RETURNING FROM IRAQ USING MENTAL HEALTH SERVICES WITHIN FIRST YEAR BACK HOME
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
SAVE THE DATE: JAMA will present new research from its theme issue on women’s health at a media briefing on Tuesday, March 21, at the Waldorf-Astoria hotel in New York. Program and registration information will be provided in a future email.
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TV Note: This week's JAMA video news release is on the use of mental health services by military personnel returning from Iraq and Afghanistan. The release will be fed Tuesday, February 28, 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, February 28, 2006
Media Advisory: To contact corresponding author Albert Schomig, M.D., email: aschoemig{at}dhm.mhn.de. To contact editorial author Robert A. Kloner, M.D., Ph.D., call Jon Weiner at 323-442-2830.
A STEM CELL MOBILIZATION THERAPY APPEARS TO BE INEFFECTIVE IN REPAIRING DAMAGE CAUSED BY HEART ATTACK
CHICAGO—Therapy that involved bone marrow stem cells did not improve cardiac function in patients following a heart attack, according to a study in the March 1 issue of JAMA.
There has been increasing evidence that stem cells contribute to regeneration of cardiac tissue and the development of new blood vessels following a heart attack, thus opening up new prospects for stem-cell based therapies. Granulocyte colony-stimulating factor (G-CSF, a growth-factor protein) induces mobilization of bone marrow stem cells, according to background information in the article.
Dietlind Zohlnhöfer, M.D., of the Technische Universität, Munich, Germany, and colleagues conducted a randomized, double-blind, placebo-controlled study (REVIVAL-2) to assess the value of G-CSF treatment in a large group of patients following a heart attack. The 114 patients, diagnosed with ST-segment elevation acute myocardial infarction (a certain pattern on an electrocardiogram indicating a heart attack), had successful reperfusion (restoration of blood flow) to the heart by percutaneous coronary intervention (procedures such as angioplasty in which a catheter-guided balloon is used to open a narrowed coronary artery) within 12 hours after onset of symptoms. Patients were randomly assigned to receive by injection either a daily dose of 10 µg/kg of G-CSF or placebo (an inactive substance) for 5 days. The patients were treated between February 2004 and February 2005.
Treatment with G-CSF produced a significant mobilization of bone marrow stem cells. The researchers found that this did not alter infarct size (area of damage) or left ventricular function after a heart attack. “Moreover, in contrast to other studies, no increase in the risk of restenosis (narrowing again of an artery after treatment) or major adverse cardiac events was observed with G-CSF treatment,” the authors write.
“The REVIVAL-2 trial had a cohort that was larger than all 3 previous trials taken together and had a relatively long follow-up period based on sensitive assessment methods of left ventricular function and infarct size. In conclusion, use of G-CSF therapy to mobilize bone marrow–derived stem cell does not improve left ventricular recovery in patients with acute myocardial infarction after successful mechanical reperfusion,” they write.
(JAMA. 2006;295:1003-1010. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support and financial disclosure information, please see the JAMA article.
EDITORIAL: ATTEMPTS TO RECRUIT STEM CELLS FOR REPAIR OF ACUTE MYOCARDIAL INFARCTION — A DOSE OF REALITY
In an accompanying editorial, Robert A. Kloner, M.D., Ph.D., of the University of Southern California, Los Angeles, discusses the findings of Zohlnhöfer and colleagues.
“Even 3 to 6 hours after acute myocardial infarction [AMI], certain therapies still may benefit the heart. However, therapies aimed at recruiting stem cells and regenerating new myocardium [heart muscle] remain experimental and have yet to be proven effective in large, long-term multicenter trials in which therapies are administered in a randomized, placebo-controlled, double-blind fashion and the size of the initial myocardial infarction and baseline cardiac function are taken into account. The study by Zohlnhöfer et al yielded negative results and some investigators may be disappointed with these results or may try to find fault with the study.”
“However, this investigation is one of the first, controlled, larger, and more carefully designed studies to assess the effect of an attempt to recruit stem cells to an AMI. Additional large, carefully designed trials are needed to assess the true potential (or possibly lack of potential) of stem cell therapy to treat AMI. ...Only with such trials will it be possible to differentiate between the hype often generated by smaller, less well-controlled trials and reality.”
(JAMA. 2006;295:1058-1059. 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, February 28, 2006
Media Advisory: To contact Charles W. Hoge, M.D., call Chuck Dasey at 301-619-2736.
COMBAT DUTY IN IRAQ LINKED WITH HIGH USE OF MENTAL HEALTH SERVICES
CHICAGO—About one-third of U.S. military personnel from the war in Iraq access mental health services after their return home, according to a study in the March 1 issue of JAMA.
The U.S. military has conducted population-level screening for mental health problems among all service members returning from deployment to Afghanistan, Iraq, and other locations. To date, no systematic analysis of this program has been conducted, and studies have not assessed the impact of these deployments on mental health care utilization after deployment, according to background information in the article. Such information is an important part of measuring the mental health burden of the current war and assuring that there are adequate resources to meet the mental health care needs of veterans returning from Iraq and Afghanistan.
Previous research conducted after other military conflicts has shown that deployment and exposure to combat result in increased risk of posttraumatic stress disorder (PTSD), major depression, substance abuse, functional impairment in social and employment settings, and the increased use of health care services.
Charles W. Hoge, M.D., of Walter Reed Army Institute of Research, Silver Spring, Md., and colleagues conducted a study to determine the relationship between deployment to Iraq and Afghanistan and mental health care use during the first year after return home. The researchers analyzed the results of the Post-Deployment Health Assessment completed by Army soldiers and Marines between May 1, 2003, and April 30, 2004, on return from deployment to Afghanistan (n=16,318), Iraq (n=222,620), and other locations (n=64,967). Health care utilization and occupational outcomes were measured for 1 year after deployment or until leaving the service if this occurred sooner. The assessment screened for such conditions as posttraumatic stress disorder, major depression, and other mental health problems.
The prevalence rates of mental health problems and combat experiences were consistently higher following deployment to Iraq than Afghanistan or other locations. Overall, 19.1 percent of soldiers and Marines who returned from Iraq met the risk criteria for a mental health concern, compared with 11.3 percent for Afghanistan and 8.5 percent for other locations.
Exposure to a combat situation was correlated with screening positive for PTSD among Iraq veterans. Of 21,822 service members who screened positive for PTSD after returning from Iraq, 79.6 percent reported witnessing persons being wounded or killed or engaging in direct combat during which they discharged their weapon compared with 47.8 percent of 200,798 who screened negative for PTSD.
Iraq veterans used inpatient and outpatient mental health services at higher rates after deployment than Afghanistan veterans and service members who deployed to other locations. Among 222,620 Iraq veterans, 31 percent were documented to have had at least 1 outpatient mental health care visit within the first year postdeployment. The annualized rate of utilization of mental health services among Iraq veterans was 35 percent. This included 12 percent per year who accessed services for a mental health problem. More than 50 percent of those referred for a mental health reason were documented to receive follow-up care although less than 10 percent of all service members who received mental health treatment were referred through the screening program.
“...this study provides new data showing the strong relationship between combat duty and a variety of mental health outcomes and most importantly high mental health care utilization in the first year after deployment. The findings have important implications for estimating the level of mental health services that may be needed in military, Veterans Affairs, and civilian practice settings that care for returning veterans. Additional research is needed beyond a year after deployment to determine the long-term burden that this war will have on the mental health care system,” the authors write.
(JAMA. 2006;295:1023-1032. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was funded by an intramural program of the U.S. Army Medical Research and Materiel Command, Ft. Detrick, Md.
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, February 28, 2006
Media Advisory: To contact Misa Imaizumi, M.D., email: misaima{at}rerf.or.jp. To contact editorial author John D. Boice, Jr., Sc.D., call Heather Hall at 615-936-7245.
ATOMIC BOMB SURVIVORS WHO HAD HIGHER RADIATION EXPOSURE SHOW INCREASED INCIDENCE OF THYROID DISEASES
CHICAGO—Survivors of the two atomic bombs in Japan 60 years ago who had a higher exposure to radiation now have a greater incidence of certain thyroid diseases, including tumors and cysts, and that risk increases with being younger at the time of exposure, according to a study in the March 1 issue of JAMA.
Thyroid disease has become an important target with which to study the effects of radiation. Many studies have reported that the risk for malignant and benign thyroid nodules increased with external and internal radiation exposure in people exposed at young ages, although few studies have followed exposed populations for long periods, such as more than 50 years, according to background information in the article.
Misa Imaizumi, M.D., of the Radiation Effects Research Foundation, Nagasaki and Hiroshima, Japan, and colleagues conducted a comprehensive thyroid disease survey between 2000 and 2003 to diagnose thyroid nodules (malignant and benign) and autoimmune thyroid diseases in survivors of the 1945 atomic bombs in Hiroshima and Nagasaki. The researchers determined the radiation dose-response relationships for these thyroid diseases. The study included 4,091 participants (average age, 70).
Thyroid diseases were identified in 44.8 percent of the total participants. In 3,185 participants, excluding persons exposed in utero, not in the city at the time of the atomic bombings, or with unknown radiation dose, the prevalence of all solid nodules, malignant tumors, benign nodules, and cysts was 14.6 percent, 2.2 percent, 4.9 percent, and 7.7 percent, respectively. The prevalence of all solid nodules, malignant tumors, benign nodules and cysts was significantly associated with thyroid radiation dose. The researchers estimate that 28 percent of all solid nodules, 37 percent of malignant tumors, 31 percent of benign nodules and 25 percent of cysts were associated with radiation exposure. No significant dose-response relationship was observed for positive antithyroid antibodies, antithyroid antibody–positive hypothyroidism, or Graves disease (an inflammatory disorder of the thyroid gland).
The interaction of age at exposure with dose was significant for the prevalence of all solid nodules, benign nodules, and other solid nodules, showing that the dose effects were significantly higher in those exposed when young. “...participants with age at exposure of younger than 20 years show significant dose-response relationships, while those with age at exposure of 20 years or older showed no significant dose response,” the authors write.
“The present study revealed that, 55 to 58 years after radiation exposure, a significant linear dose-response relationship existed in the prevalence of not only malignant thyroid tumors but also benign thyroid nodules and that the relationship was significantly higher in those exposed at younger ages. On the other hand, autoimmune thyroid diseases were not found to be significantly associated with radiation exposure in this study. Careful examination of the thyroid is still important long after radiation exposure, especially for people exposed at younger ages,” the researchers conclude.
(JAMA. 2006;295:1011-1022. Available pre-embargo to the media at www.jamamedia.org)
EDITORIAL: THYROID DISEASE 60 YEARS AFTER HIROSHIMA AND 20 YEARS AFTER CHERNOBYL
In an accompanying editorial, John D. Boice, Jr., Sc.D., of the International Epidemiology Institute, Rockville, Md., and Vanderbilt University School of Medicine, Nashville, Tenn., comments on the study on radiation dose and thyroid disease.
“The risk following exposures [to radiation] in childhood apparently lasts for life, although it appears that the risk declines many years after exposure. The radiosensitivity of the young thyroid gland is high and most likely relates to subsequent proliferative activity of the gland during puberty and growth, but the reasons for the absence of risk following adult exposures are not entirely clear. The risk of thyroid cancer seems to be enhanced if diets deficient in stable iodine result in chronic thyroid stimulation.”
(JAMA. 2006;295:1060-1062. 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, February 28, 2006
Media Advisory: To contact Anne R. Cappola, M.D., Sc.M., call Susanne Hartman at 215-349-5964.
OVERACTIVE THYROID ASSOCIATED WITH DEVELOPMENT OF ABNORMAL HEART RHYTHM, BUT NOT OTHER CARDIOVASCULAR PROBLEMS
CHICAGO—Having an overactive thyroid gland is linked with an increased risk for atrial fibrillation (a type of abnormal heart rhythm), but neither an over- or under active thyroid gland is associated with a higher risk for other cardiovascular problems or increased risk of death, according to a study in the March 1 issue of JAMA.
Thyroid hormone excess and deficiency are common, and can be readily diagnosed and treated. Previous studies have suggested that abnormal levels of thyroid stimulating hormone (TSH) may represent a cardiac risk factor. Cardiovascular diseases (CVD) are the most common cause of death in the U.S. Even mildly altered thyroid status reportedly affects serum cholesterol levels, heart rhythm and rate, ventricular function, risk of coronary artery disease, and cardiovascular death. However, the relationship between abnormal thyroid function and cardiovascular outcomes remains unclear, according to background information in the article.
Anne R. Cappola, M.D., Sc.M., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues tested the hypothesis that abnormal thyroid status is associated with increased cardiovascular risk and death in individuals with unrecognized thyroid dysfunction. The study included 3,233 U.S. individuals aged 65 years or older who had their serum thyroid-stimulating hormone levels measured when enrolled in 1989-1990. The cardiovascular health of the patients, who were not taking thyroid medication, was assessed through June 2002.
The researchers found that 82 percent of participants had normal thyroid function, 15 percent had subclinical (before symptoms) hypothyroidism (an underactive thyroid gland), 1.6 percent had symptomatic hypothyroidism, and 1.5 percent had subclinical hyperthyroidism (an overactive thyroid gland). After exclusion of those who had atrial fibrillation at the start of the study, individuals with subclinical hyperthyroidism had nearly twice the incidence of developing atrial fibrillation compared with those with normal thyroid function. No differences were seen between the subclinical hyperthyroidism group and the normal thyroid function group for the occurrence of coronary heart disease, cerebrovascular disease, cardiovascular death, or all-cause death. Likewise, there were no differences between the subclinical hypothyroidism or symptomatic hypothyroidism groups and the normal thyroid function group for cardiovascular outcomes or death.
“Our analyses do not support screening older individuals solely to prevent atrial fibrillation, with an estimated number needed to screen of 2,500 older individuals to find 1 case of atrial fibrillation associated with subclinical hyperthyroidism. Our findings suggest that if endogenous [originating from within the thyroid] subclinical hyperthyroidism is detected, older individuals may benefit from treatment to prevent atrial fibrillation,” the authors write. “Our analyses do not support screening older individuals for thyroid disease to prevent CVD, and, although our data are observational, they do not support treatment of individuals with subclinical hypothyroidism to prevent cardiovascular events.”
(JAMA. 2006;295:1033-1041. 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
ONE-THIRD OF SOLDIERS AND MARINES RETURNING FROM IRAQ USING MENTAL HEALTH SERVICES WITHIN FIRST YEAR BACK HOME
VIDEO:
***All combat video provided by U.S. Dept. of Defense***
Major Geoffrey Grammer walking down hallway
Soldiers in Iraq listening to commander
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ARMY PSYCHIATRIST MAJOR GEOFFREY GRAMMER SPENT A YEAR IN IRAQ HELPING SOLDIERS COPE WITH COMBAT. HE HIMSELF WAS SHOT AT...
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Soldiers/sound of gunfire
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(Gunfire)
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Building
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...AND WAS A TARGET OF MORTAR EXPLOSIONS.
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Building exploding (same shot)
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(Explosion)
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Super: Maj. Geoffrey Grammer, M.D.
Army psychiatrist
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“It was one of those times where you sit there and you say I can’t believe this is happening to me, I don’t have any other choice but to sort of wall this off and move on and tend to the mission at hand.”
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Medics treating wounded soldiers
Dr. Hoge and colleagues discussing data
Soldiers with guns drawn
Helicopter
Soldiers with guns
GFX/JAMA Cover
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BUT EVENTUALLY, SOLDIERS MUST DEAL WITH THEIR COMBAT EXPERIENCES. DR. CHARLES HOGE AND COLLEAGUES AT WALTER REED ARMY INSTITUTE OF RESEARCH STUDIED ABOUT 300-THOUSAND MILITARY SERVICE MEMBERS WHO RETURNED HOME FROM IRAQ, AFGHANISTAN OR OTHER DEPLOYMENT LOCATIONS BETWEEN 2003 AND 2004. THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
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Super: Col. Charles Hoge, M.D.
Walter Reed Army Institute of Research
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“The study shows that soldiers who are returning from Iraq, that a higher percentage of those soldiers report mental health concerns and use mental health services when they get home from Iraq compared to soldiers who are returning from deployment to Afghanistan or other locations.”
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Nighttime explosion
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Soldiers exploring compound
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THAT’S BECAUSE SOLDIERS IN IRAQ SEE MORE FREQUENT AND INTENSE COMBAT. ABOUT TWENTY PERCENT REPORTED MENTAL HEALTH CONCERNS, BUT ULTIMATELY MORE THAN THAT, ABOUT ONE-THIRD, RECEIVED MENTAL HEALTH EVALUATION OR COUNSELING IN THE FIRST YEAR HOME. TWELVE PERCENT WERE DIAGNOSED WITH A MENTAL HEALTH PROBLEM.
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Walter Reed Army Institute of Research
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“The most important finding of the study, though, is that most of the services that soldiers are receiving, mental health services, they’re coming in to get care early, within the first two months particularly of coming home. And this is very encouraging.”
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BECAUSE EARLY TREATMENT MAKES A BIG DIFFERENCE IN MENTAL HEALTH. SO THE MILITARY IS MAKING A BIG PUSH TO GET SOLDIERS MENTAL HEALTH CARE.
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Maj. Geoffrey Grammer, M.D.
Army psychiatrist
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“People are doing absolutely heroic things over in Iraq and Afghanistan on behalf of this country, and they deserve the best possible care that we can give them.”
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AND THAT INCLUDES MENTAL HEALTH CARE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
