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, September 12, 2006)
JAMA NEWS RELEASES
'WAIT-AND-SEE' APPROACH FOR TREATING EAR INFECTION IN CHILDREN SUBSTANTIALLY REDUCES USE OF ANTIBIOTICS
CONSUMPTION OF GREEN TEA ASSOCIATED WITH REDUCED MORTALITY IN JAPANESE ADULTS
STUDY IDENTIFIES FACTORS ASSOCIATED WITH INCREASED RISK OF CARDIAC ARREST FOR ADOLESCENTS WITH CERTAIN HEART CONDITIONS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
'WAIT AND SEE' TREATMENT STRATEGY FOR EAR INFECTIONS CAN REDUCE ANTIBIOTIC USE
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Embargoed for Release: 3:00 p.m. CT, Tuesday, September 12, 2006
Media Advisory: To contact David M. Spiro, M.D., M.P.H., call Tamara Hargens at 503-494-8653. To contact editorial author Paul Little, M.B.B.S., M.D., F.R.C.G.P., or email: p.little{at}soton.ac.uk.
'WAIT-AND-SEE’ APPROACH FOR TREATING EAR INFECTION IN CHILDREN SUBSTANTIALLY REDUCES USE OF ANTIBIOTICS
CHICAGO—For children with acute ear infections seen in an emergency department, giving parents the option of delaying use of antibiotics resulted in significantly lower use of antibiotics compared to parents who received a standard prescription, with little difference in the outcomes for the children, according to a study in the September 13 issue of JAMA.
Acute otitis media (AOM; ear infection) is the most common reason for which an antibiotic is prescribed to children. Treatment of AOM accounts for an estimated 15 million antibiotic prescriptions written per year in the United States, according to background information in the article. Untreated AOM has a high rate of natural resolution, with similar rates of complications whether antibiotics are prescribed or withheld. Resistance to antibiotics is a major public health concern worldwide and is associated with the widespread use of antibiotics.
David M. Spiro, M.D., M.P.H., formerly of the Yale University School of Medicine, New Haven, Conn., and colleagues conducted a study to determine whether treatment of AOM using a "wait-and-see prescription" (WASP) significantly reduced use of antibiotics compared with a "standard prescription" (SP), and evaluated the effects of this intervention on clinical symptoms and adverse outcomes. Overall, 283 children with AOM aged 6 months to 12 years seen in an emergency department were randomly assigned to receive either a WASP (n = 138) or a SP (n = 145). All patients received ibuprofen and ear analgesic drops for use at home. Phone interviews were conducted after enrollment to determine outcomes. The trial was conducted between July 2004 and July 2005.
The researchers found that the WASP significantly reduced the use of antibiotics. Substantially more parents in the WASP group did not fill the antibiotic prescription, compared to the SP group (62 percent vs. 13 percent). There was no statistically significant difference between the groups in the frequency of subsequent fever, otalgia (ear ache), or unscheduled visits for medical care. The patients in the WASP group whose parents filled the prescription reported they did so because of fever (60 percent), otalgia (34 percent), or fussy behavior (6 percent). No serious adverse events were reported for patients in the study.
"This randomized controlled trial has provided evidence that the WASP strategy significantly reduces the use of antibiotics in an urban population presenting to an emergency department and may be an alternative to routine treatment of AOM with antibiotics. Wait-and-see prescriptions remain controversial as most pediatricians in the United States have been trained to routinely prescribe antibiotics for AOM and believe that many parents expect a prescription; a small minority of practitioners who care for children routinely use watchful waiting.
"The WASP approach may interrupt the cycle of antibiotic prescription, the expectation of parents to immediately treat AOM with an antibiotic, and subsequent medical visits for this illness. The risks of antibiotics, including gastrointestinal symptoms, allergic reactions, and accelerated resistance to bacterial pathogens must be weighed against their benefits for an illness that, for the most part, is self limited. The routine use of WASP for AOM will reduce both the costs and adverse effects associated with antibiotic treatment and should reduce selective pressure for organisms resistant to commonly used antimicrobials,"the authors conclude.
(JAMA. 2006;296:1235-1241. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Spiro is now with Oregon Health and Science University, Portland. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: DELAYED PRESCRIBING — A SENSIBLE APPROACH TO THE MANAGEMENT OF ACUTE OTITIS MEDIA
In an accompanying editorial, Paul Little, M.B.B.S., M.D., F.R.C.G.P., of the University of Southampton, Aldermoor Health Centre, Southampton, U.K., comments on the findings of Spiro and colleagues.
"Further evidence is needed to inform clinicians about when to use delayed prescribing. Studies are needed to define children at risk of adverse outcomes. For instance, most severely ill children and children about whom the physician was concerned for other reasons will not have entered the trial by Spiro et al or other trials. Further studies also are needed to determine the most effective alternatives to antibiotics. However, given the current evidence base, a reasonable approach would be as follows. When the child is not systemically ill and the physician has no major concerns, delayed prescribing can be used. If the physician has concerns about sicker or at risk patients (e.g., those with systemic symptoms or comorbidity, infants younger than 6 months), then antibiotics should be prescribed.
"If parents are given clear information about the timing of antibiotic use and specific guidelines for signs and symptoms that should trigger reassessment, delayed prescribing probably has its place, should be acceptable to parents, appears reasonably safe, and provides a significant step in the battle against antibiotic resistance.”
(JAMA. 2006;296:1290-1291. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Little reports that he has served as a paid consultant for Abbott Laboratories for 2 sessions regarding the complications of respiratory infections.
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, September 12, 2006
Media Advisory: To contact Shinichi Kuriyama, M.D., Ph.D., email: kuriyama-thk@umin.ac.jp.
CONSUMPTION OF GREEN TEA ASSOCIATED WITH REDUCED MORTALITY IN JAPANESE ADULTS
CHICAGO—Adults in Japan who consumed higher amounts of green tea had a lower risk of death due to all causes and due to cardiovascular disease, according to a study in the September 13 issue of JAMA. But there was no link between green tea consumption and a reduced risk of death due to cancer.
Tea is the most consumed beverage in the world aside from water. Three billion kilograms of tea are produced each year worldwide, according to background information in the article. Because of the high rates of tea consumption in the global population, even small effects in humans could have large implications for public health. Among teas, green tea polyphenols have been extensively studied as cardiovascular disease (CVD) and cancer chemopreventive agents. Although substantial evidence from in vitro and animal studies indicates that green tea preparations may impede CVD and carcinogenic processes, the possible protective role of green tea consumption against these diseases in humans remains unclear.
Shinichi Kuriyama, M.D., Ph.D., of the Tohoku University School of Public Policy, Sendai, Japan, and colleagues examined the association between green tea consumption and mortality (death rate) due to all causes, CVD, and cancer within a large population. The study, initiated in 1994, included 40,530 adults (age 40 to 79 years) in northeastern Japan, where green tea is widely consumed. Within this region, 80 percent of the population drinks green tea and more than half of them consume 3 or more cups and day. The participants, who had no history of stroke, coronary heart disease, or cancer at baseline, were followed for up to 11 years (1995-2005) for all-cause death and for up to 7 years (1995-2001) for cause-specific death.
Over 11 years of follow-up, 4,209 participants died, and over 7 years of follow-up, 892 participants died of cardiovascular disease and 1,134 participants died of cancer. The researchers found that green tea consumption was inversely associated with death due to all causes and due to cardiovascular disease. Compared with participants who consumed less than 1 cup/d of green tea, those who consumed 5 or more cups/d had a risk of all-cause mortality and CVD mortality that was 16 percent lower (during 11 years of follow-up) and 26 percent lower (during 7 years of follow-up), respectively.
These inverse associations of all-cause and CVD mortality were stronger among women, although the inverse association for green tea consumption was observed in both sexes. In women, compared with those who consumed less than 1 cup/d of green tea, those who consumed 5 or more cups/d had a 31 percent lower risk of CVD death.
The researchers found there no significant association between green tea consumption and death from cancer. There were weak or neutral relationships between black tea or oolong tea and mortality.
"Clinical trials are ultimately necessary to confirm the protective effect of green tea on mortality,"the authors write.
(JAMA. 2006;296:1255-1265. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by a Health Sciences Research Grant for Health Services, Ministry of Health, Labour, and Welfare, Japan. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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, September 12, 2006
Media Advisory: To contact corresponding author Arthur J. Moss, M.D., call Greg Williams at 585-273-1757.
STUDY IDENTIFIES FACTORS ASSOCIATED WITH INCREASED RISK OF CARDIAC ARREST FOR ADOLESCENTS WITH CERTAIN HEART CONDITIONS
CHICAGO—Researchers have identified several factors that are linked with an increased risk for cardiac arrest and sudden cardiac death among adolescents with long-QT syndrome (an abnormality of the electrical conducting system of the heart, characterized by a specific finding on the ECG), according to a study in the September 13 issue of JAMA.
Risk factors for cardiac events such as aborted cardiac arrest (when an episode of cardiac arrest is reversed, such as with defibrillation) and sudden cardiac death in adolescents with hereditary long QT syndrome (LQTS) have not been previously investigated, according to background information in the article.
Jenny B. Hobbs, M.D., of the University of Rochester Medical Center, Rochester, N.Y., and colleagues identified the association of clinical factors and therapeutic interventions with risk of aborted cardiac arrest and sudden cardiac death in 2,772 adolescents with clinically suspected LQTS. The participants were from the International Long QT Syndrome Registry who were alive at age 10 years and were followed up during adolescence until age 20. Follow-up ended in Feb. 2005. The registry enrollment began in 1979 at 5 cardiology centers in the United States and Europe.
There were 81 patients who experienced aborted cardiac arrest, 45 who had sudden cardiac death; 9 of the 81 patients who had an aborted cardiac arrest event experienced subsequent sudden cardiac death. Significant independent predictors of aborted cardiac arrest or sudden cardiac death during adolescence included recent syncope (loss of consciousness), QTc interval (a certain measurement on an electrocardiogram), and sex. Among those 10 to 12 years old, males had 4 times the risk of females of the same age, whereas there was no significant sex difference among those 13 to 20 years old.
Compared with those with no syncopal events in the last 10 years, patients with 1 syncopal episode in the last 2 years had nearly 12 times the risk for a life-threatening event; those with 2 or more syncopal episodes in the last 2 years had about 18 times the risk. Among individuals with syncope in the past 2 years, β-blocker therapy was associated with a 64 percent reduced risk.
"In summary, we identified 3 important factors for estimating the risk of life-threatening events in adolescent patients with suspected LQTS: timing and frequency of recent syncope, the duration of the QTc interval, and sex. This clinically oriented risk-stratification approach might serve as a useful guide for prophylactic treatment decisions to reduce the risk of sudden death in patients with LQTS during the high-risk teenage years", the authors write.
(JAMA. 2006;296:1249-1254. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
'WAIT AND SEE' TREATMENT STRATEGY FOR EAR INFECTIONS CAN REDUCE ANTIBIOTIC USE
VIDEO:
NAT SOT UP FULL FOR: 04
Pediatrician examining little girl’s ear
AUDIO:
“Let’s take a look in your ear for a second.”
VIDEO:
B-ROLL
Pediatrician examining little girl’s ear
Dr. Spiro examining small boy’s ears
Bottle of liquid antibiotic
AUDIO:
EAR INFECTIONS ARE VERY COMMON IN YOUNG KIDS. TO TREAT THE INFECTIONS, MANY DOCTORS PRESCRIBE ANTIBIOTICS LIKE THIS.
VIDEO:
NAT SOT UP FULL FOR :04
Mom with boy on lap, talking to doctor
AUDIO:
“The first time he got amoxicillin, and then he got augmentin.”
VIDEO:
B-ROLL
GFX/JAMA COVER
Different pediatrician examining girl’s ear
Mom with small boy on lap in exam room
Antibiotic being poured into cup
AUDIO:
BUT A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SHOWS THE BENEFIT OF A “WAIT AND SEE” APPROACH, LETTING PARENTS WAIT TWO DAYS, AND IF THE CHILD DOESN’T GET BETTER, THEN FILL THE ANTIBIOTICS PRESCRIPTION.
VIDEO:
SOT/FULL
@ :27
Super: David Spiro, M.D., M.P.H.
Oregon Health and Science University
Runs :17
AUDIO:
“One half of the children in our study received a wait and see prescription for an antibiotic and the other half received a prescription and the parents were told to fill it immediately. Both groups were given both ibuprofen and ear drops for pain.”
VIDEO:
B-ROLL
Dr. Spiro with small boy and boy’s mom in exam room
Exterior of OHSU
Pan from Dr. Spiro to boy’s face
AUDIO:
DR. DAVID SPIRO (speer-oh), A PEDIATRIC EMERGENCY ROOM PHYSICIAN AT OREGON HEALTH AND SCIENCE UNIVERSITY, WAS ONE OF THE RESEARCHERS WHO CONDUCTED THIS STUDY.
VIDEO:
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David Spiro, M.D., M.P.H.
Oregon Health and Science University
Runs :15
AUDIO:
“Roughly two-thirds of parents in the wait and see group did not fill the prescription, and that group recovered at the same rate as children who received instructions to fill the antibiotic prescription.”
VIDEO:
B-ROLL
Pediatrician examining girl’s ear
Syringe filling with antibiotic liquid
AUDIO:
IN OTHER WORDS, MANY OF THE CHILDREN WITH EAR INFECTIONS GOT BETTER WITHOUT ANTIBIOTICS.
VIDEO:
SOT/FULL
David Spiro, M.D., M.P.H.
Oregon Health and Science University
Runs :15
AUDIO:
“Parents should be empowered to make a decision at 48 hours whether to fill or not fill an antibiotic prescription and this strategy could significantly reduce antibiotic use in the United States.”
VIDEO:
B-ROLL
Dr. Spiro with small boy and boy’s mom in exam room
Mom with child on her lap
AUDIO:
AUDIO: THIS MOM SAYS SHE’D BE WILLING TO TRY THE WAIT AND SEE APPROACH THE NEXT TIME HER SON GETS AN EAR INFECTION. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
