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, October 3, 2006)
JAMA NEWS RELEASES
SIGNIFICANT DECLINE OF SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES SEEN SINCE START OF PRE-PARTICIPATION SCREENING PROGRAM IN ITALY
STUDY IDENTIFIES FACTORS CORRELATED WITH CEREBRAL PALSY
EFFECTIVENESS OF CERTAIN ANTIDEPRESSANTS MAY BE INFLUENCED BY GENE VARIATIONS OF INDIVIDUALS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
SCREENING PROGRAM TO DETECT HEART CONDITIONS REDUCED RATE OF SUDDEN DEATH IN YOUNG ATHLETES BY NEARLY 90%
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the change in sudden cardiac deaths among young athletes after the start of a pre-participation screening program. The report will be fed Tuesday, October 3, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, October 3, 2006
Media Advisory: To contact corresponding author Gaetano Thiene, M.D., email: gaetano.thiene{at}unipd.it. To contact editorial co-author Paul D. Thompson, M.D., call Carolyn Pennington at 860-679-4864.
SIGNIFICANT DECLINE OF SUDDEN CARDIAC DEATHS IN YOUNG ATHLETES SEEN SINCE START OF PRE-PARTICIPATION SCREENING PROGRAM IN ITALY
CHICAGO—The annual incidence of sudden cardiovascular deaths among young athletes has declined significantly since the start of a pre-participation cardiovascular screening program in northeast Italy, according to a study in the October 4 issue of JAMA.
The majority of young athletes who die suddenly have previously unsuspected structural heart disease. Medical evaluation of athletes before competition offers the potential to identify those without symptoms of potentially deadly cardiovascular abnormalities. Italian law mandates that prior to participating in competitive sports activity, every athlete must undergo a clinical evaluation and obtain eligibility, according to background information in the article. A nationwide systematic screening program was launched in Italy in 1982, which includes a detailed history, physical examination, and an electrocardiogram (ECG); the program has been shown to be effective in identifying athletes with certain heart disorders. However, the long-term impact of such a screening program on prevention of sudden cardiovascular death in athletes has not been known.
Domenico Corrado, M.D., Ph.D., of the University of Padua Medical School, Italy and colleagues analyzed the changes in incidence rates and causes of sudden cardiovascular death in young athletes (age 12 to 35 years) in the Veneto region of Italy between 1979 and 2004, after introduction of systematic pre-participation screening. A parallel study examined trends in cardiovascular causes of disqualification from competitive sports in 42,386 athletes undergoing pre-participation screening at the Center for Sports Medicine in Padua (22,312 in the early screening period [1982-1992] and 20,074 in the late screening period [1993-2004]).
During the study period, 55 sudden cardiovascular deaths occurred in screened athletes (1.9 deaths/100,000 person-years) and 265 sudden deaths in unscreened nonathletes (0.79 deaths/100,000 person-years). Person-years is the number of people in the study times the number of years of follow-up per person. The annual incidence of sudden cardiovascular death in athletes decreased by 89 percent, from 3.6/100,000 person-years in 1979-1980 to 0.4/100,000 person-years in 2003-2004; the incidence of sudden death among the unscreened nonathletic population did not change significantly over that time.
The decline in the death rate started after mandatory screening was started and persisted to the late screening period. Compared with the pre-screening period (1979 – 1981), the relative risk of sudden cardiovascular death was 44 percent lower in the early screening period (1982 – 1992) and 79 percent lower in the late screening period (1993 – 2004). Most of the reduced death rate was due to fewer cases of sudden death from cardiomyopathies (disorder of the heart muscle). During the study period, 2 percent of the athletes were disqualified from competition due to cardiovascular causes.
“All these findings suggest that screening athletes for cardiomyopathies is a life-saving strategy and that 12-lead ECG is a sensitive and powerful tool for identification and risk stratification of athletes with cardiomyopathies,” the authors write. “These data demonstrate the benefit of the current Italian screening program and have important implications for implementing screening strategies for prevention of sudden death in athletes in other countries.”
(JAMA. 2006;296:1593-1601. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded by the Veneto Region, Cardiocerebrovascular Pathology Registry, Venice, Italy; a European Commission research contract; the Ministry of Health, Rome; and Fondazione Cassa di Risparmio di Padova e Rovigo, Padova, Italy. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PROTECTING ATHLETES FROM SUDDEN CARDIAC DEATH
In an accompanying editorial, Paul D. Thompson, M.D., of Hartford Hospital and the University of Connecticut, Hartford, and Benjamin D. Levine, M.D., of Presbyterian Hospital and the University of Texas Southwestern Medical Center, Dallas, discuss the findings regarding pre-participation screening of young athletes.
“The study by Corrado et al provides the best evidence to date supporting the pre-participation screening of athletes and provocative evidence for including ECGs in this process. However, cardiologists and other physicians involved in the evaluation of athletes can take a valuable lesson from Corrado et al, and collaborate to develop a rigorous, comprehensive regional or national registry to study the pre-participation screening process prospectively and directly, and to determine how to implement such programs most effectively and how to manage asymptomatic athletes with cardiac abnormalities detected by the screening process.”
(JAMA. 2006;296:1648-1650. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures - none 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, October 3, 2006
Media Advisory: To contact Martin Bax, D.M., F.R.C.P.C.H., email: m.bax{at}imperial.ac.uk. To contact editorial author Michael E. Msall, M.D., call Theresa Carson at 773-702-6241.
STUDY IDENTIFIES FACTORS CORRELATED WITH CEREBRAL PALSY
CHICAGO—Several factors, including maternal infection during pregnancy, very preterm birth, and certain findings on brain MRI scans were correlated with cerebral palsy, according to a study in the October 4 issue of JAMA.
Magnetic resonance imaging (MRI) findings have been reported for specific clinical cerebral palsy (CP) subgroups or lesion types but not in a large population of children with all CP subtypes. Additional information about the causes of CP could help identify preventive strategies, according to background information in the article.
Martin Bax, D.M., F.R.C.P.C.H., of Imperial College London and Chelsea & Westminster Hospital, London, and colleagues examined the correlates of CP in a population sample and compared clinical findings with information available from MRI brain scans. The study included 585 children with CP who were born between 1996 and 1999; 431 children were clinically assessed and 351 had a brain MRI scan at 18 months of age or later. The research was conducted at eight European study centers (North West London and North East London, England; Edinburgh, Scotland; Lisbon, Portugal; Dublin, Ireland; Stockholm, Sweden; Tübingen, Germany; and Helsinki, Finland).
The researchers found that 39.5 percent (158 of 400) of the mothers reported an infection during the pregnancy, including 19.2 percent who reported a urinary tract infection and 15.5 percent who reported taking antibiotics during the pregnancy. Fifty-one children (12 percent) were known to be from a multiple pregnancy, with 48 from a twin pregnancy and 3 from a triplet pregnancy. This compares with a population rate of multiple pregnancy of about 1.5 percent. In addition, 235 children (54 percent) were born at term, whereas 47 children (10.9 percent) were very preterm (born less than 28 weeks gestation), 69 (16 percent) were born between 28 and 31 weeks, and 79 (18.3 percent) were born between 32 and 36 weeks gestation. Emergency cesarean deliveries were performed in 32.3 percent of births.
Among children with clinical evaluation, 351 (81.4 percent) had a brain MRI scan assessed for the study. The scans showed that white-matter damage of immaturity (brain areas affected due to not being fully developed) was the most common finding (42.5 percent). Only 11.7 percent of these children had normal MRI findings. There were good correlations between the MRI and clinical findings.
“Not only do MRI scans help reveal the pathologic basis of the condition but, also, the findings have strong correlations with clinical findings. This may be useful in helping parents, clinicians, and others involved in the care of children with CP to understand the nature of the children’s condition and to predict their needs in the future. Therefore, all children with CP should have an MRI scan,” the authors write.
“We think it is not unreasonable to assume that with increased awareness of possible preventive measures, over the next decade the rate of CP could be reduced substantially, thus reducing the burden on families and saving tremendous sums of money for health services,” the researchers conclude.
(JAMA. 2006;296:1602-1608. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Ongoing funding for this study is provided by the Castang Foundation, having been initiated by the Little Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: COMPLEXITY OF THE CEREBRAL PALSY SYNDROMES
In an accompanying editorial, Michael E. Msall, M.D., of the University of Chicago Pritzker School of Medicine, University of Chicago Comer Children’s and LaRabida Children’s Hospitals, Chicago, comments on the study by Bax and colleagues.
“The key translational question is how to use advances in maternal-fetal medicine, neonatology, and developmental neuroscience to describe the best explanatory mechanisms for children with a CP syndrome. Most important is how to use the best science to understand potential pathways that would decrease the functional severity of CP.”
“With respect to ongoing management, a long-term whole-child focus that optimizes health, developmental, and functional outcomes, community participation, and family well-being is in order. In this way, an informed and compassionate science for children with neurodisability can be developed.”
(JAMA. 2006;296:1650-1652. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures - none reported. Please see the editorial for information on funding/support.
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, October 3, 2006
Media Advisory: To contact co-author Bernard J. Carroll, M.B., Ph.D., call 831-626-1467.
EFFECTIVENESS OF CERTAIN ANTIDEPRESSANTS MAY BE INFLUENCED BY GENE VARIATIONS OF INDIVIDUALS
CHICAGO—Whether specific types of antidepressants are effective for patients with late-life major depression may depend if they have certain genetic variations, according to a study in the October 4 issue of JAMA.
Initial drug treatments fail in 30 percent to 40 percent of patients with major depression. Pharmacogenetic (the relation of genetic factors to variations in response to drugs) prediction of response is one possibility for improving antidepressant treatment, according to background information in the article. Polymorphisms (occurrence in more than one form) in the serotonin transporter gene (5-HTT) may influence antidepressant response to selective serotonin reuptake inhibitors (SSRIs – a class of antidepressant drugs).
Hyeran Kim, M.D., of Sungkyunkwan University School of Medicine, Seoul, Korea, and colleagues conducted a study to determine whether there were significant associations between the efficacy of norepinephrine reuptake inhibitors (NRIs - a class of antidepressant drugs) and norepinephrine transporter (NET) polymorphisms and also between SSRI efficacy and 5-HTT polymorphisms. If confirmed, these associations could provide a basis for predicting response to certain antidepressants. The study included 241 Korean patients with major depression. They were treated for 6 weeks with an SSRI (fluoxetine or sertraline; n = 136) or an NRI (nortriptyline; n = 105) antidepressant. The average age at onset of major depressive disorder among these patients was in the early to mid-50s.
The researchers found that the presence of certain polymorphisms, alone or in combination, was associated with response and non-response to therapy with SSRIs or NRIs.
They write that their data analysis suggests that patients carrying the GG polymorphism of NET G1287A have a statistically significantly superior rate of response to NRI treatment than to SSRI treatment (83.3 percent vs. 58.7 percent).
“…this study demonstrates that the responses to antidepressants with different targets have significant associations with homologous monoamine transporter gene polymorphisms. Our data confirm a relationship between SSRI response and 5-HTT polymorphisms, and establish an association between NRI response and the NET G1287A polymorphism. We also found that the 5-HTTLPR s/l variation plays a role in the treatment of depression with both NRI and SSRI agents. The results of this study need to be confirmed in other populations, using selective NRIs other than nortriptyline. Additional studies in younger populations with depression are also needed,” the researchers write. “Confirmation of these preliminary findings would permit refined pharmacogenetic selection of antidepressant treatment.”
(JAMA. 2006;296:1609-1618. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by grants from the Korea Health Research and Development Project, Ministry of Health and Welfare, Republic of Korea. 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
SCREENING PROGRAM TO DETECT HEART CONDITIONS REDUCED RATE OF SUDDEN DEATH IN YOUNG ATHLETES BY NEARLY 90%
VIDEO:
B-ROLL
Teen boy entering exam room
Teen boys playing soccer
Doctor attaching electrodes to teen’s chest
Pan from monitor showing heart activity to doctor
AUDIO:
LIKE ALL YOUNG ITALIAN ATHLETES, THIS TEEN MUST UNDERGO A MEDICAL SCREENING BEFORE HE’S ALLOWED TO PLAY SPORTS. AND THIS SCREENING IS LOOKING FOR SOMETHING SPECIFIC… HEART PROBLEMS THAT MIGHT NOT HAVE APPARENT SIGNS OR SYMPTOMS.
VIDEO:
SOT/FULL
@ :12
Super: Gaetano Thiene, M.D.
Padua Center for Sports Medicine
Runs :16
AUDIO:
“The major effort indeed is to identify these people and then disqualify from sport activity. Don’t forget that the sport activity and effort is a trigger for sudden death in people affected.”
VIDEO:
B-ROLL
Let video run through name
Exterior of Center for Sports Medicine
Young men/Rugby players running
Close up teen boy’s face
Wider shot/teen on bike with electrodes on chest
Close-up electrodes on chest
AUDIO:
DR. GAETANO (guy-TAHN-oh) THIENE (Tee- EN-ah) OF THE CENTER FOR SPORTS MEDICINE AND PHYSICAL ACTIVITY IN PADUA, ITALY, WAS PART OF A STUDY ABOUT PREVENTING SUDDEN DEATH IN ATHLETES. THE DOCTORS CAREFULLY SCREENED MORE THAN 40-THOUSAND YOUNG ITALIAN ATHLETES, AGES TWELVE TO THIRTY-FIVE, FOR SIGNS OF HEART PROBLEMS BY USING THE PATIENT’S HISTORY AND PERFORMING A PHYSICAL EXAM AND ELECTROCARDIOGRAM.
VIDEO:
SOT/FULL
Gaetano Thiene, M.D.
Padua Center for Sports Medicine
Runs :11
AUDIO:
“The screening was able to identify people affected by concealed disease and disqualify them from sport activity.”
VIDEO:
B-ROLL
GFX/JAMA COVER
More screening/exam – doctor listening with stethoscope
Teens playing soccer
Runs :17
AUDIO:
BUT THAT’S NOT ALL THE STUDY, WHICH APPEARS IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, FOUND. THE MAJOR FINDING WAS THAT OVER TWENTY-SIX YEARS, THE PRE-PARTICIPATION SCREENING REDUCED THE INCIDENCE OF SUDDEN DEATH IN YOUNG ATHLETES BY ALMOST NINETY PERCENT.
VIDEO:
SOT/FULL
Gaetano Thiene, M.D.
Padua Center for Sports Medicine
Runs :14
AUDIO:
“And this was absolutely amazing because this was proving that the pre-participation screening is a life-saving tool.”
VIDEO:
B-ROLL
Pan from teen/electrodes on chest to doctor
AUDIO:
DR. THIENE SAYS HE HOPES OTHER COUNTRIES WILL FOLLOW ITALY’S LEAD AND MAKE THE SCREENING, WHICH COSTS ABOUT FORTY U-S DOLLARS PER PERSON, MANDATORY.
VIDEO:
SOT/FULL
Gaetano Thiene, M.D.
Padua Center for Sports Medicine
Runs :08
AUDIO:
“This pre-participation screening should also be implemented elsewhere, for instance, in North America where it is not existing yet.”
VIDEO:
B-ROLL
Teens playing soccer
AUDIO:
IN ITALY, IT’S SAVING LIVES. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
