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 17, 2006)
JAMA NEWS RELEASES
HEART TRANSPLANT FROM ORGAN DONOR WITH HEPATITIS C ASSOCIATED WITH DECREASED SURVIVAL
PRE-OPERATIVE BREATHING TRAINING HELPS DECREASE RISK OF COMPLICATIONS FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY
LARGE NUMBER OF ADVERSE DRUG EVENTS OCCUR OUTSIDE THE HOSPITAL AND LEAD TO EMERGENCY DEPARTMENT VISITS
REVIEW OF PREVIOUS STUDIES INDICATES HEALTH BENEFITS FROM EATING FISH OUTWEIGH RISKS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
WORKPLACE SMOKING BAN IMPROVED BAR WORKERS’ HEALTH IN AS LITTLE AS ONE MONTH
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 health benefits and risks of fish consumption. The report will be fed Tuesday, October 17, 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.
Save the Date: JAMA will present new research from its theme issue on men’s health at a media briefing on Tuesday, November 14, at the Millennium Broadway Hotel in New York. Program and registration information will be provided in a future email.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
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Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 17, 2006
Media Advisory: To contact Leanne B. Gasink, M.D., M.S.C.E., call Rick Cushman at 215-349-5659.
To contact editorial co-author Robert H. Rubin, M.D., call Kevin Myron at 617-534-1605.
HEART TRANSPLANT FROM ORGAN DONOR WITH HEPATITIS C ASSOCIATED WITH DECREASED SURVIVAL
CHICAGO—Heart transplant patients who receive a donor heart from a person with hepatitis C have a lower rate of survival, according to a study in the October 18 issue of JAMA.
A shortage of cardiac organ donors results in a substantial number of deaths among persons awaiting cardiac transplantation. One potential approach for increasing the availability of donors is to broaden the criteria used to identify appropriate donors. For example, the cardiac donor pool could be expanded by using donors with hepatitis C virus (HCV) infection. Hearts from donors infected with HCV carry a substantial risk of transmission of HCV to the recipient, and high rates of subsequent liver enzyme abnormalities have been observed, according to background information in the article. The effect on patient survival has not been clear.
Leanne B. Gasink, M.D., M.S.C.E., of the University of Pennsylvania School of Medicine, Philadelphia, and colleagues conducted a study to determine the relationship between donor HCV status and survival in cardiac transplant recipients. The study included data from the Scientific Registry of Transplant Recipients. Adult heart transplant patients who received their transplants between April 1994 and July 2003 were eligible for inclusion. Of 10,915 patients meeting entry criteria, 261 received an HCV-positive donor heart.
The researchers found that the rate of death was higher among recipients of hearts from HCV-positive donors compared with recipients of hearts from HCV-negative donors at 1 year (16.9 percent vs. 8.2 percent), 5 years (41.8 percent vs. 18.5 percent), and 10 years (50.6 percent vs. 24.3 percent). At 1, 5, and 10 years, survival rates were 83 percent, 53 percent, and 25 percent for recipients of HCV-positive donor hearts, and 92 percent, 77 percent, and 53 percent for recipients of HCV-negative donor hearts, respectively. This association appears to be independent of recipient HCV status and age. Recipients of HCV-positive donor hearts were more likely to die of liver disease and coronary vasculopathy (disease of the coronary arteries).
“Preferential allocation of HCV-positive donors to HCV-positive recipients and/or older recipients is not warranted,” the authors conclude.
(JAMA. 2006;296:1843-1850. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Internal funds provided by Division of Cardiology at the University of Pennsylvania were used to obtain data from the Scientific Registry of Transplant Recipients (SRTR). Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: POORER OUTCOMES FOR RECIPIENTS OF HEART ALLOGRAFTS FROM HCV-POSITIVE DONORS
In an accompanying editorial, Amir A. Qamar, M.D., and Robert H. Rubin, M.D., of Harvard Medical School and Brigham and Women’s Hospital, Boston, comment on the findings of Gasink and colleagues.
“The question that remains is how patients should be managed in the face of a potential organ donor who is HCV positive. The results of the study by Gasink et al, demonstrating a survival disadvantage among heart transplant recipients who had HCV-positive donors, provide support for the position that transplanting hearts from HCV-positive donors should be avoided if possible. Studies in other organ recipients suggest similar results. Exceptions could be made for critically ill patients who will not survive without a transplant.”
(JAMA. 2006;296:1900-1901. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – Dr. Rubin reports that he has received grants for research and education from Pfizer, Merck and Amgen.
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 17, 2006
Media Advisory: To contact Erik H. J. Hulzebos, P.T., M.Sc., email: h.hulzebos{at}umcutrecht.nl.
PRE-OPERATIVE BREATHING TRAINING HELPS DECREASE RISK OF COMPLICATIONS FOLLOWING CORONARY ARTERY BYPASS GRAFT SURGERY
CHICAGO—Patients at high-risk of developing pulmonary complications such as pneumonia following coronary artery bypass graft surgery can reduce their risk through breathing exercises and respiratory muscle training before the operation, according to a study in the October 18 issue of JAMA.
Despite improvements in coronary artery bypass graft (CABG) surgery and care around the time of the operation, the rate of postoperative pulmonary complications (PPCs) has remained stable, possibly because CABG surgery is now performed in more fragile (high-risk) patients at greater risk of PPCs. Postoperative pulmonary complications continue to have an effect on patient illness and risk of death, length of hospital stay, and overall use of resources, according to background information in the article. The prehospitalization period before CABG surgery could be used to improve a patient’s pulmonary condition. The effectiveness of preoperative inspiratory (breathing in) muscle training (IMT) in reducing the incidence of PPCs in high-risk patients undergoing CABG surgery has previously not been determined.
In this study, IMT consisted of preoperatively individualized, tailored exercises, 7 times a week, for at least 2 weeks before the actual date of surgery, and included education in breathing techniques; forced expiration techniques; and use of a spirometry, to measure the capacity of the lungs.
Erik H. J. Hulzebos, P.T., M.Sc., of the University Medical Center, Utrecht, the Netherlands and colleagues examined the effectiveness of preoperative physical therapy, including IMT, on the incidence of PPCs, especially pneumonia, in patients at high risk of developing PPCs who underwent CABG surgery. Enrollment in the randomized clinical trial was conducted between July 2002 and August 2005. Of 655 patients referred for elective CABG surgery, 299 (45.6 percent) met criteria for high risk of developing PPCs, of whom 279 were enrolled and followed up until discharge from hospital. Patients were randomly assigned to receive either preoperative IMT (n = 140) or usual care (n = 139). Both groups received the same postoperative physical therapy.
In patients at high risk of developing PPCs, IMT resulted in significant improvement in average inspiratory muscle strength and respiratory muscle endurance.
After CABG surgery, PPCs were present in 25 (18.0 percent) of 139 patients in the IMT group and 48 (35.0 percent) of 137 patients in the usual care group, a reduction in incidence of PPCs of 48 percent. The incidence of pneumonia was 6.5 percent in the IMT group and 16.1 percent in the usual care group. The median (middle value) duration of postoperative hospitalization was 7 days (range, 5-41 days) in the IMT group vs. 8 days (range, 6-70 days) in the usual care group.
“We found that preventive physical therapy with IMT administered to patients at high risk of PPCs before CABG surgery was associated with an increase in inspiratory force and a decrease in the incidence of PPCs and length of hospitalization. We consider this to be an important presurgical intervention that appears to be effective at reducing morbidity,” the authors conclude.
(JAMA. 2006;296:1851-1857. 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.
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 17, 2006
Media Advisory: To contact Daniel S. Budnitz, M.D., M.P.H., call Jennifer Morcone at 404-639-1690.
LARGE NUMBER OF ADVERSE DRUG EVENTS OCCUR OUTSIDE THE HOSPITAL AND LEAD TO EMERGENCY DEPARTMENT VISITS
CHICAGO—Each year, an estimated 700,000 persons experience adverse drug events that lead to emergency department visits, according to a study in the October 18 issue of JAMA.
Outpatient use of drug therapies in the United States is common. In 2004, 82 percent of the U.S. population reported using at least 1 prescription medication, over-the-counter medication, or dietary supplement in the previous week and 30 percent reported using 5 or more of these drugs, according to background information in the article. While these medications may offer substantial benefits, there also may be risks. Information on outpatient adverse drug events (ADEs) has been difficult to estimate, but the problem is large and can be expected to increase.
Daniel S. Budnitz, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed data from the National Electronic Injury Surveillance System–Cooperative Adverse Drug Event Surveillance project (NEISS-CADES) to determine the frequency and characteristics of ADEs in the U.S. that have led to emergency department visits. The study included data from Jan. 2004 through Dec. 2005.
Over the 2-year study period, 21,298 adverse drug event cases were reported. “Based on data from a nationally representative surveillance system, we estimate that more than 700,000 patients were treated for ADEs in U.S. emergency departments annually in 2004 and 2005, and 1 of every 6 required subsequent hospital admission, transfer to another health care facility, or emergency department observation admission. Individuals aged 65 years or older were more than twice as likely to be treated in emergency departments for an ADE and nearly 7 times as likely to require hospitalization as individuals younger than 65 years. Among all patients who were hospitalized, most ADEs were due to unintentional overdoses and two-thirds of these were due to toxicity from a relatively small set of drugs for which regular monitoring is commonly required to prevent acute toxicity. Sixteen of the 18 drugs most commonly causing ADEs have been in clinical use for more than 20 years,” the authors write.
Adverse drug events accounted for 2.5 percent of estimated emergency department visits for all unintentional injuries and 6.7 percent of those leading to hospitalization, and also accounted for 0.6 percent of estimated emergency department visits for all causes.
Insulins or warfarin, drugs that typically require ongoing monitoring to prevent overdose or toxicity, were implicated in 1 in every 7 estimated ADEs treated in emergency departments.
“The finding that individuals aged 65 years or older (12 percent of the U.S. population) accounted for one-quarter of ADEs overall and half of adverse events requiring hospitalization highlights the importance of directing ADE prevention efforts to this vulnerable population. Emergency department visits for ADEs in this age group were nearly as common as those for motor vehicle occupant injuries,” the authors write.
“Efforts to reduce the burden of outpatient ADEs have been hampered by sparse data, except in selected health care systems or settings. Ongoing data collection in NEISS-CADES will enable more detailed examination of the epidemiology of emergency department-treated outpatient ADEs, focusing on specific patient populations, drug classes, conditions, and circumstances. Identifying appropriate measures of drug exposure and evaluating drug risks in relation to drug benefits remain important challenges in improving the quality of outpatient drug therapy,” the researchers write.
(JAMA. 2006;296:1858-1866. 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.
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 17, 2006
Media Advisory: To contact Dariush Mozaffarian, M.D., Dr.P.H., call Todd Datz at 617-432-3952.
REVIEW OF PREVIOUS STUDIES INDICATES HEALTH BENEFITS FROM EATING FISH OUTWEIGH RISKS
CHICAGO—Despite the risks of possible contaminants, the health benefits of consuming fish, including a lower rate of death from heart disease, exceed the potential risks, according to a review of previous studies, published in the October 18 issue of JAMA.
Fish has been considered a healthy food since the publication of studies demonstrating its various health benefits. Several studies have identified two long-chain n-3 polyunsaturated fatty acids (n-3 PUFAs), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), as likely playing a role in the associated lower rates of coronary heart disease with fish consumption. Conversely, concern has arisen over potential harm from mercury, dioxins, and polychlorinated biphenyls (PCBs) present in some fish species. The public is faced with conflicting reports on the risks and benefits of eating fish, resulting in controversy over the role of fish consumption in a healthy diet.
Dariush Mozaffarian, M.D., Dr.P.H., and Eric B. Rimm, Sc.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, reviewed the scientific evidence for adverse and beneficial health effects of fish consumption (in this article defined as finfish or shellfish). They searched MEDLINE, governmental reports, and meta-analyses to identify reports published through April 2006 evaluating (1) intake of fish or fish oil and cardiovascular risk, (2) effects of methylmercury and fish oil on early neurodevelopment, (3) risks of methylmercury for cardiovascular and neurologic outcomes in adults, and (4) health risks of dioxins and PCBs in fish. When possible, meta-analyses were performed to characterize benefits and risks most precisely.
The researchers found that modest consumption of fish (e.g., 1-2 servings/wk), especially species higher in n-3 fatty acids (EPA, DHA), reduces risk of coronary death by 36 percent and the rate of death by 17 percent, and may favorably affect other clinical outcomes. Intake of 250 mg/d of EPA and DHA appears sufficient for primary prevention. This corresponds to one 6-oz. serving/wk of wild salmon or similar oily fish, or more frequent intake of smaller or less n-3 PUFA–rich servings.
DHA appears beneficial for, and low-level methylmercury may adversely affect, early neurodevelopment. Women who are or may become pregnant and nursing mothers should avoid selected species (shark, swordfish, golden bass, and king mackerel; locally caught fish per local advisories) and limit intake of albacore tuna (6 oz./wk) to minimize methylmercury exposure. “However, emphasis must also be placed on adequate consumption—12 oz./wk—of other fish and shellfish to provide reasonable amounts of DHA and avoid further decreases in already low seafood intake among women (74 percent of women of childbearing age and 85 percent of pregnant women consume less than 6 oz./wk),” the researchers write.
Health effects of low-level methylmercury in adults are not clearly established; methylmercury may modestly decrease the cardiovascular benefits of fish intake.
“A variety of seafood should be consumed; individuals with very high consumption (5 servings or more per week) should limit intake of species highest in mercury levels. Levels of dioxins and PCBs in fish are low, and potential carcinogenic and other effects are outweighed by potential benefits of fish intake and should have little impact on choices or consumption of seafood.”
“Avoidance of modest fish consumption due to confusion regarding risks and benefits could result in thousands of excess coronary heart disease deaths annually and suboptimal neurodevelopment in children,” the authors conclude.
(JAMA. 2006;296:1885-1899. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note:This study was supported by a grant from the National Heart, Lung, and Blood Institute, National Institutes of Health. 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
COMPREHENSIVE STUDY FINDS HEALTH BENEFITS OF EATING FISH GREATLY OUTWEIGH HEALTH RISKS
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NAT SOT UP FULL FOR :06
Older man
Older woman
Younger man
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“I eat fish five times a week.”
“At least once a week.”
“Probably I would say once or twice a week.”
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Younger man eating fish
Older man eating fish
GFX/JAMA COVER
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THESE FISH FANS SAY THEY’VE HEARD ABOUT THE HEALTH RISKS OF EATING FISH, ESPECIALLY ABOUT MERCURY, BUT THAT THEY CARE MORE ABOUT THE BENEFITS. A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SAYS THEY’RE RIGHT.
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Super: Dariush Mozaffarian, M.D., Dr.P.H.
Harvard School of Public Health
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“The benefits of eating fish are far greater than the potential risks.”
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Dr. Mozaffarian walking outside
Harvard School of Public Health sign, pan up to building
Whole fish being laid in ice next to other whole fish
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DR. DARIUSH (DAR-ee-ush) MOZAFFARIAN (moz-uh-FAR-ee-un) IS A RESEARCHER AT HARVARD SCHOOL OF PUBLIC HEALTH AND HARVARD MEDICAL SCHOOL. HE AND HIS COLLEAGUES REVIEWED HUNDREDS OF STUDIES ABOUT FISH AND HEALTH. THEY DID FIND THAT FISH CONTAINS MERCURY, BUT…
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Dariush Mozaffarian, M.D., Dr.P.H.
Harvard School of Public Health
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“If you eat a fish, and it has some mercury in it, you might be getting less benefit from that fish than if it didn’t have mercury in it, but the overall benefit is still positive.”
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Man eating fish
Woman eating fish
Cooked steak on plate
Salad in bowl
Pan of seafood case with many varieties of fish –covers top of next bite through "childbearing"
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THE SAME GOES FOR P-C-Bs AND DIOXINS, WHICH IN VERY LARGE DOSES CAN CAUSE CANCER. TURNS OUT WE GET MUCH MORE OF THOSE IN MEAT, DAIRY AND VEGGIES THAN WE DO IN FISH. SOME WOMEN DO NEED TO AVOID FISH HIGH IN MERCURY THOUGH, BECAUSE MERCURY CAN AFFECT BRAIN DEVELOPMENT.
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Dariush Mozaffarian, M.D., Dr.P.H.
Harvard School of Public Health
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Shot of swordfish covers bite starting at “swordfish”
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“For women of childbearing age, nursing mothers and young children, our findings agreed with the conclusions of the FDA and the advisory of the FDA. That was really that there are four fish those women should avoid. Shark, swordfish, golden bass and king mackerel.”
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Young woman eating fish
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BUT OTHERWISE, THOSE WOMEN SHOULD EAT ABOUT TWO SERVINGS OF FISH A WEEK.
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Dariush Mozaffarian, M.D., Dr.P.H.
Harvard School of Public Health
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Man eating fish covers bite starting at “enough”
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“We found that a modest intake of fish, about one or two servings per week, was enough to reduce the risk of dying from a heart attack by about 35%, which is a considerable effect.”
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Backtime Kelly
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THAT MEANS A LOT TO KELLY LABS.
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Super: Kelly Labs
Eats fish regularly
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“I actually have some heart disease in my family so that’s kind of why we’ve started eating fish at a young age.”
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Chef putting salmon on grill
Salmon on grill
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SHE SAYS SHE HAS NO DOUBT ABOUT THE BENEFITS OF EATING FISH. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
