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, June 27, 2006)
JAMA NEWS RELEASES
COGNITIVE BEHAVIORAL THERAPY APPEARS MORE EFFECTIVE THAN SLEEP MEDICATION FOR TREATING INSOMNIA
INCREASED NIGHTTIME BLOOD PRESSURE MAY BE LINKED TO HIGHER RISK FOR CONGESTIVE HEART FAILURE
STUDY DOCUMENTS OUTBREAK OF FUNGAL EYE INFECTIONS AMONG CONTACT LENS WEARERS IN SINGAPORE
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
DEPRESSION ASSOCIATED WITH INCREASED RISK OF HEART DISEASE AND HEART FAILURE
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 27, 2006
Media Advisory: To contact Borge Sivertsen, Psy.D., email: borge.sivertsen{at}psykp.uib.no.
COGNITIVE BEHAVIORAL THERAPY APPEARS MORE EFFECTIVE THAN SLEEP MEDICATION FOR TREATING INSOMNIA
CHICAGO—Patients with insomnia who implemented cognitive behavioral therapy interventions such as relaxation techniques had greater improvement in their sleep than patients who received the sleep medication zopiclone, according to a study in the June 28 issue of JAMA.
Insomnia is usually defined as subjective complaints of poor sleep accompanied by impairment in daytime function. It is common in people aged older than 55 years (9 percent-25 percent are affected) and is associated with reduced quality of life, depression, and more physician visits. Despite these links to individuals’ lives and societal costs, most people with chronic insomnia–up to 85 percent–remain untreated, according to background information in the article. Two-thirds of individuals with insomnia report having poor knowledge of available treatment options, and as many as one fifth resort to either untested over-the-counter medications or alcohol in attempts to improve their condition. Among primary care physicians, the treatment of choice for insomnia has commonly been prescription medication. Cognitive behavioral therapy (CBT) is the most widely used psychological intervention for insomnia. No studies have compared the newer non-benzodiazepine sleep medications with nonpharmacological treatments.
Borge Sivertsen, Psy.D., of the University of Bergen, Norway, and colleagues conducted a randomized controlled trial between January 2004 and December 2005 to compare the short- and long-term clinical efficacy of CBT and the non-benzodiazepine sleep medication zopiclone. The trial included 46 adults (average age 60.8 years; 22 women) with chronic primary insomnia. The participants received either the CBT intervention (information on sleep hygiene, sleep restriction, stimulus control, cognitive therapy, and progressive relaxation technique; n = 18), sleep medication (7.5 mg zopiclone each night; n = 16), or placebo medication (n = 12). All treatment duration was 6 weeks, and the 2 active treatments were followed up at 6 months. Clinical polysomnographic data and sleep diaries were used to determine total wake time, total sleep time, sleep efficiency, and slow-wave sleep (only assessed using polysomnography [PSG; monitoring of physiological activity during sleep]).
Using PSG testing, the total time spent awake during the night for the CBT group improved significantly more than both the placebo group at 6 weeks and the zopiclone group at both 6 weeks and 6 months. The zopiclone group did not differ significantly from the placebo group. Total wake time at 6 weeks was reduced 52 percent in the CBT group compared with 4 percent and 16 percent in the zopiclone and placebo groups on PSG testing, respectively. On average, participants receiving CBT improved their PSG-registered sleep efficiency by 9 percent at posttreatment, compared with a decline of 1 percent in the zopiclone group, a difference that the authors stated was both statistically and clinically significant.
Total sleep time measured using both PSG and sleep diary increased significantly in the CBT group at 6 months compared with 6 weeks. The zopiclone group showed no significant change at 6 months on PSG, maintaining improvements seen at 6 weeks. Comparing the 2 active treatment conditions, total wake time, sleep efficiency, and slow-wave sleep were all significantly better in the CBT group than in the zopiclone group as assessed using PSG; total sleep time was not significantly different .
“...the present findings have important implications for the clinical management of chronic primary insomnia in older adults. Given the increasing amount of evidence of the lasting clinical effects of CBT and lack of evidence of long-term efficacy of hypnotics, clinicians should consider prescribing hypnotics only for acute insomnia. At present, CBT-based interventions for insomnia are not widely available in clinical practice, and future research should focus on implementing low-threshold treatment options for insomnia in primary care settings. As recently demonstrated by Bastien et al, telephone consultations and CBT-based group therapy for younger patients with insomnia produced equally significant improvements as individual therapy sessions. In another study, CBT delivered via the Internet in a self-help format showed significant improvements in individuals with chronic insomnia,” the authors write. “Finally, future research should seek to identify which single factors in the CBT regimen produce the best results and to what extent booster sessions at 1 to 2 years after initial treatment may be necessary to maintain improvements.”
(JAMA. 2006;295:2851-2858. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was funded by grants from the University of Bergen, the Meltzer Fund and the EXTRA funds from the Norwegian Foundation for Health and Rehabilitation.
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, June 27, 2006
Media Advisory: To contact Erik Ingelsson, M.D., Ph.D., email: erik.ingelsson{at}pubcare.uu.se.
INCREASED NIGHTTIME BLOOD PRESSURE MAY BE LINKED TO HIGHER RISK FOR CONGESTIVE HEART FAILURE
CHICAGO—Having a relatively high blood pressure level at night may increase the risk for congestive heart failure, according to a study in the June 28 issue of JAMA.
Congestive heart failure (CHF) is one of the most common, costly, disabling, and deadly diseases. Once diagnosed as having CHF, patients have a 1 in 3 chance of dying within 1 year and a 2 in 3 chance of dying within 5 years, according to background information in the article. The death rate associated with CHF exceeds that of most cancers, although recent reports suggest an improving prognosis. The predominant causes of CHF are hypertension and coronary heart disease, and high blood pressure (BP) is suggested to be the most important risk factor for CHF. Previous studies have established that 24-hour BP measurements, which provide information that is not obtained from conventional office-based BP measurement, such as average BP over a 24-hour period and night-day patterns, are powerful predictors of cardiovascular illness and death. However, no previous studies have examined 24-hour ambulatory (as opposed to office-measured) BP as a predictor of CHF in persons free of CHF at baseline.
Erik Ingelsson, M.D., Ph.D., of Uppsala University, Uppsala, Sweden, and colleagues analyzed BP characteristics of 951 elderly men, free of CHF, valvular disease, and left ventricular hypertrophy at baseline between 1990 and 1995. They followed the participants until the end of 2002. Twenty-four-hour ambulatory blood pressure monitoring was performed at baseline, and the blood pressure variables were analyzed as predictors of subsequent CHF.
Seventy men developed heart failure during follow-up. In analysis adjusted for antihypertensive treatment and established risk factors for CHF (heart attack, diabetes, smoking, body mass index, and serum cholesterol level), a 9–mm Hg increase in nighttime ambulatory diastolic blood pressure and the presence of “nondipping” blood pressure (BP that is at least as high at night as during the day) were associated with an increased risk of CHF. Nighttime ambulatory diastolic blood pressure and nondipping blood pressure were also significant predictors of CHF after excluding all participants who had a heart attack before baseline or during follow-up.
Furthermore, a nondipping nighttime BP pattern increased the risk of CHF even after adjusting for conventional office BP measurement. “This indicates that nighttime BP patterns may be important in development of CHF and that a traditional office BP measurement does not capture all of the increased risk that an increased nighttime BP conveys,” the authors write.
“Nighttime BP appears to convey additive risk information about CHF, but its clinical value remains to be established in future studies.”
(JAMA. 2006;295:2859-2866. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Funding was provided by Primary Health Care in Uppsala County, the Swedish Heart Lung Foundation (Hjärt-Lungfonden), and the Thuréus Foundation. Co-author Lars Lind, M.D., Ph.D., is a part-time employee at AstraZeneca Research and Development, Mölndal, Sweden, and a part-time employee at Uppsala University (AstraZeneca has no interests in this project and has not provided any financial support). No other disclosures were reported.
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, June 27, 2006
Media Advisory: To contact corresponding author Donald T.H. Tan, F.R.C.S., e-mail: snecdt{at}pacific.net.sg.
STUDY DOCUMENTS OUTBREAK OF FUNGAL EYE INFECTIONS AMONG CONTACT LENS WEARERS IN SINGAPORE
CHICAGO—Researchers in Singapore have reported an outbreak of Fusarium keratitis (a fungal infection of the cornea) associated with soft contact lens wear and linked with use of certain contact lens cleaning solutions, according to an article in the June 28 issue of JAMA.
Keratitis, an inflammation of the cornea, is a potentially blinding infection and is one of the most severe complications associated with contact lens use. However, outbreaks of fungal keratitis are rare in contact lens wearers. Since March 1, 2005, Singapore has seen a sharp increase in the number of keratitis cases caused by the Fusarium fungus species. Recent reports have also confirmed that 122 patients in the U.S. and 33 in Hong Kong have developed Fusarium keratitis, suggesting that this outbreak may be part of a global problem for contact lens wearers, according to information in the article.
Wei-Boon Khor, M.B.B.S., of the Singapore Eye Research Institute, and colleagues examined the Fusarium keratitis outbreak in Singapore. All cases of fungal keratitis among contact lens wearers from March 2005 through May 2006 were included in the study. Researchers collected corneal samples and patients’ contact lenses, lens cases and current bottle of contact lens solution for testing. Telephone interviews were also conducted.
During the 15-month period, 66 contact lens wearers (68 affected eyes) were diagnosed with Fusarium keratitis. From this, the researchers estimated that the annual national incidence of Fusarium keratitis was 2.35 cases for every 10,000 contact lens wearers in Singapore. Nearly all patients wore soft, disposable contact lenses (98.5 percent) and a high proportion (93.9 percent) reported using ReNu brand cleaning solution, including 42 patients (63.6 percent) who reported using ReNu with MoistureLoc. Most patients (81.8 percent) had poor lens hygiene habits, including wearing daily contacts overnight, wearing expired lenses and wearing contacts while swimming. The authors suggest that these habits, however, cannot fully account for the outbreak. Two-thirds of patients (n = 44) had severe, sight-threatening lesions requiring an average first-visit hospital stay of 6.5 days, and five patients required corneal transplantation.
“We believe that Singapore is facing a new and unprecedented outbreak of Fusarium keratitis and that this is the first time that such an outbreak has been reported among contact lens wearers anywhere in the world,” the authors write. “A national case-control study currently under way will shed further light on the probable risk factors for this outbreak, including the role of contact lens solutions.” The authors conclude by encouraging physicians and clinicians to “maintain a high index of suspicion for fungal infection when evaluating and treating patients with contact lens-associated microbial keratitis.”
(JAMA. 2006;295:2867–2873. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The funding and administrative support for this study was provided by the Singapore Eye Research 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
DEPRESSION ASSOCIATED WITH INCREASED RISK OF HEART DISEASE AND HEART FAILURE
VIDEO:
SOT/FULL
@ :02
Super: Mary Whooley, M.D.
VA Medical Center/UCSF
Runs :07
AUDIO:
“Does having a positive attitude really prolong your life? Or the opposite, does feeling low make you more susceptible to illness?”
VIDEO:
B-ROLL
Bite covers to “with”
Exterior of VA
Dr. Whooley with heart patient on treadmill
GFX/JAMA COVER
AUDIO:
THIS IS DR. MARY WHOOLEY, AN INTERNIST WITH THE VETERANS AFFAIRS MEDICAL CENTER AND UNIVERSITY OF CALIFORNIA, SAN FRANCISCO. TO ANSWER HER QUESTIONS, SHE DECIDED TO REVIEW ALL THE PUBLISHED RESEARCH SHE COULD FIND ON THE LINK BETWEEN HEART DISEASE AND DEPRESSION. HER FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Mary Whooley, M.D.
VA Medical Center/UCSF
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D“The majority of studies have found that depression is associated with an increased risk of heart attacks. This means that depression is not only affecting one’s mental health, it may also affect one’s physical health.”
VIDEO:
FULL SCREEN GRAPHIC over sonogram image
1 out of every 3 heart failure patients has depression
B-ROLL
Wiley talking with Dr. Whooley in office
AUDIO:
IN FACT, SHE FOUND THAT ONE OUT OF EVERY THREE HEART FAILURE PATIENTS HAS DEPRESSION. THIS ASSOCIATION DOES NOT SURPRISE WILEY COWAN. HE’S HAD HEART HEALTH ISSUES… SUCH AS TWO STROKES AND A QUADRUPLE BYPASS.
VIDEO:
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Super: Wiley Cowan
Heart patient
Runs :08
AUDIO:
“The heart issues surfaced just a few years ago but I feel that I have suffered from depression for a great many years.”
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B-ROLL
Pan from heart monitor to patient on treadmill
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SO WHY WOULD DEPRESSION AFFECT HEART HEALTH?
VIDEO:
B-roll runs over bite through “depression have”
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Mary Whooley, M.D.
VA Medical Center/UCSF
Runs :16
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“It may be that patients with depression have elevated levels of stress hormones that might damage their heart or there may be behavioral consequences of depression such as not taking mediations as prescribed or not eating as well or not exercising that may damage the heart.”
VIDEO:
B-ROLL
Patient on treadmill – male physician checking her blood pressure
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DR. WHOOLEY SAYS THAT PHYSICIANS AND PATIENTS SHOULD CONSIDER DEPRESSION WHEN TREATING PHYSICAL ILLNESSES.
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Mary Whooley, M.D.
VA Medical Center/UCSF
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“Treating the depression first may help the patients recover from their other illnesses even better.”
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Backtime into bite
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THAT MAKES SENSE TO WILEY COWAN.
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Wiley Cowan
Heart patient
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“It’s a good holistic approach.”
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Patient on treadmill, pan to heart monitor screen
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ONE THAT COULD HELP TREAT THE MIND AND THE BODY. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
