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 31, 2006)
JAMA NEWS RELEASES
REHABILITATION TECHNIQUE FOR STROKE PATIENTS EFFECTIVE IN IMPROVING ARM, HAND MOVEMENT
BLACKS IN U.S. HAVE SUICIDE ATTEMPT RATE HIGHER THAN PREVIOUSLY REPORTED
STATIN USE ASSOCIATED WITH LOWER RISK OF DEATH AND HOSPITALIZATION FOR PATIENTS WITH HEART FAILURE
BRAINSTEM ABNORMALITY LINK TO SIDS STRONGER THAN PREVIOUSLY INDICATED
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
'CONSTRAINT-INDUCED MOVEMENT THERAPY' IMPROVES HAND-ARM FUNCTION IN SOME STROKE PATIENTS BY UP TO 65% COMPARED TO USUAL CARE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on a rehabilitation technique for improving hand and arm movement in stroke patients. The report will be fed Tuesday, October 31, 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 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.
Leading researchers will present new studies on:
- Avoidance of certain risk factors in midlife linked with longer, healthier life.
- The effectiveness of adding radiation therapy to other treatments for advanced prostate cancer; the effect of testosterone replacement therapy on prostate tissue in men with low testosterone levels.
- A comparison of drug treatments for lower urinary tract and overactive bladder symptoms.
To Register: Reply to this email or go to the For the Media website at www.jamamedia.org and and click on the Events tab and then the registration link. For more information, call the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 31, 2006
Media Advisory: To contact Steven L. Wolf, Ph.D., P.T., call Holly Korschun at 404-727-3990. To contact editorial co-author Andreas R. Luft, M.D., email: aluft2{at}jhmi.edu.
REHABILITATION TECHNIQUE FOR STROKE PATIENTS EFFECTIVE IN IMPROVING ARM, HAND MOVEMENT
CHICAGO—Therapy that includes restraining the less-impaired arm or hand of a stroke patient appears effective in improving movement and functional use of the paralyzed arm or hand, according to a study in the November 1 issue of JAMA.
Each year, more than 730,000 Americans experience a new or recurrent stroke, with resulting direct health care costs totaling $35 billion, according to background information in the article. Up to 85 percent of the approximately 566,000 stroke survivors experience hemiparesis (partial paralysis affecting only one side of the body), resulting in impairment of an upper extremity immediately after stroke, and between 55 percent and 75 percent of survivors continue to experience upper-extremity functional limitations, which are associated with diminished health-related quality of life, even 3 to 6 months later.
One rehabilitation approach involves restraining the less-impaired upper extremity (arm or hand; usually by placing the entire arm in a sling or placing the hand in a mitt for most waking hours), thereby encouraging usage of the more-affected extremity (often referred to as “forced use”). This type of rehabilitation, called constraint-induced movement therapy (CIMT), includes work with a clinician and repetitive task practice. Single-site studies have suggested that a 2-week program of CIMT can improve upper-extremity function.
Steven L. Wolf, Ph.D., P.T., of the Emory University School of Medicine, Atlanta, and colleagues compared the effects of a 2-week multisite program of CIMT vs. usual care on improvement in upper-extremity function among patients who had a first stroke within the previous 3 to 9 months. The Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized, multisite clinical trial, was conducted at 7 U.S. academic institutions between January 2001 and January 2003. The study included 222 individuals with predominantly ischemic stroke. Participants were assigned to receive either CIMT (n = 106; wearing a restraining mitt on the less-affected hand while engaging in repetitive task practice and behavioral shaping with the hemiplegic [partially paralyzed] arm and hand) or usual and customary care (n = 116; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions).
Patients were evaluated using the Wolf Motor Function Test (WMFT), a measure of laboratory time and strength based ability and quality of movement (functional ability); and the Motor Activity Log (MAL), a measure of how well and how often 30 common daily activities are performed.
The researchers found that from baseline to 12 months, the CIMT group showed greater improvements than the control group in both the WMFT Performance Time, with a between-group difference of 34 percent reduction in time to complete a task; and in the MAL measurements. The CIMT group also achieved a 65 percent increase in the proportion of tasks performed with the partially-paralyzed arm, and a greater decrease in self-perceived hand function difficulty, compared to the control group.
“In summary, among patients who had experienced stroke between 3 and 9 months prior, administration of CIMT resulted in statistically significant and clinically relevant improvements in paretic arm motor ability and use compared with participants receiving usual and customary care. Improvements were present following the 2-week intervention, persisted for up to 1 year, and were not influenced by age, sex, or initial level of paretic arm function. These findings suggest that further research exploring central nervous system changes that accompany the observed motor gains and research on alternate models of CIMT delivery are warranted,” the authors write.
(JAMA. 2006;2095-2104. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This research was supported by a National Institutes of Health grant from the National Center for Medical Rehabilitation Research (National Institute of Child Health and Human Development) and the National Institute of Neurological Diseases and Stroke. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: STROKE RECOVERY—MOVING IN AN EXCITE-ING DIRECTION
In an accompanying editorial, Andreas R. Luft, M.D., of the University of Tübingen, Germany, and Daniel F. Hanley, M.D., of Johns Hopkins University, Baltimore, comment on the findings of Wolf and colleagues.
“The EXCITE trial clearly suggests that more recovery after stroke is possible than neuroscientists currently teach in professional schools or training programs and than clinicians have been telling patients to expect. Recovery of lost or impaired motor functions has been demonstrated in animal models and is biologically feasible for humans, and now has been confirmed by data from a well-designed randomized clinical trial. Knowledgeable physicians and scientists must reject the nihilism that bases the projection of best recoveries on observations of therapies without defined benefit.
“If training is new brain, many more therapeutic and mechanistic clinical trials of stroke recovery must be conducted. Despite decades of research and discovery, there is still no clear idea as to the maximal amount of benefit that can be achieved with interventions that harness the learning powers of the human brain. A little more excitement in the lives of stroke survivors can only be good,” the authors write.
(JAMA. 2006;296:2141-2143. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The authors’ research is supported by Deutsche Forschungsgemeinschaft, Interdiziplinäres Zentrum für klinische Forschung (University of Tübingen), and the NIA Claude A. Pepper program, University of Maryland and Johns Hopkins University. 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 31, 2006
Media Advisory: To contact Sean Joe, M.S.W., Ph.D., call Jared Wadley at 734-936-7819.
BLACKS IN U.S. HAVE SUICIDE ATTEMPT RATE HIGHER THAN PREVIOUSLY REPORTED
CHICAGO—New research indicates that blacks in the U.S. have a lifetime prevalence of attempted suicide of about 4 percent, a rate comparable with the general population, but higher than previous estimates, according to a study in the November 1 issue of JAMA.
Among all Americans, suicide is the 11th leading cause of death and the rates range across specific demographic subgroups. In recent years, suicide and nonfatal suicidal behavior have emerged as crucial health issues for blacks, particularly among older adolescents and young adults, according to background information in the article. Although suicide has traditionally been viewed as a problem that affects more whites, the rates of suicide among blacks have increased significantly since the mid 1980s. Lack of data on the lifetime prevalence and age at onset of suicidal thoughts, plans, and attempts among blacks in the United States have limited the development and evaluation of interventions to reduce suicide among black Americans.
Sean Joe, M.S.W., Ph.D., of the University of Michigan, Ann Arbor, and colleagues conducted a study to determine national estimates of the lifetime prevalence and risk factors for suicidal thoughts, plans, and attempts among blacks of African American and Caribbean ethnicity in the U.S. The researchers used data from the National Survey of American Life (NSAL), a national sample of 5,181 black respondents age 18 years and older, conducted between Feb. 2001 and June 2003.
The estimated lifetime prevalence of suicide attempts among blacks in the United States was 4.1 percent; for suicidal thoughts, 11.7 percent. Among those who reported suicidal thoughts, 34.6 percent made a suicide plan and 21 percent made an unplanned attempt. Significant differences were found between men and women, with attempts being more prevalent for women, 4.9 percent, than for men, 3.1 percent. The prevalence of suicide attempts was highest for Caribbean black men (7.5 percent), followed by African American women (5.0 percent). Risk of a suicide attempt and risk of suicidal thoughts were significantly associated with being younger, having a low education level, residing in the Midwest region of the U.S., and having one or more psychiatric disorders.
“The NSAL results provide evidence that black Americans have levels of suicidal thought and behaviors that are comparable with the general population,” the authors write.
“The results of the study should influence clinicians who screen patients for risk for suicide. For instance, clinicians should focus on modifiable risk factors (e.g., anxiety, depression) and should engage blacks in aggressive treatment in the high-risk period of the first year after ideation onset and continue to observe patients who attempt suicide after making a plan. Clinicians must also consider, when screening blacks, the strong association of [psychiatric] disorders with the risk for suicide attempts, the greater likelihood for young adults to be impulsive, and for older adults to engage in planned suicide attempts. It is also important that black patients at risk for impulsive attempts do not have access to firearms or medications that can be used to attempt suicide.”
(JAMA. 2006;296:2112-2123. 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 31, 2006
Media Advisory: To contact Alan S. Go, M.D., call Maureen McInaney at 510-987-4779.
STATIN USE ASSOCIATED WITH LOWER RISK OF DEATH AND HOSPITALIZATION FOR PATIENTS WITH HEART FAILURE
CHICAGO—Patients with heart failure who used statins for the first time had a reduced risk of death of nearly 25 percent, compared to non-users, and also a lower risk for hospitalization, according to a study in the November 1 issue of JAMA.
Statins effectively lower low-density lipoprotein (LDL) cholesterol level. However, some studies have indicated a higher risk of adverse events in persons with heart failure and low levels of LDL cholesterol. Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.
Alan S. Go, M.D., of Kaiser Permanente of Northern California, Oakland, Calif., and colleagues examined the association between initiation of statin therapy and risks of death and hospitalization within a large population of patients with heart failure who were eligible for lipid-lowering therapy. The study, conducted between Jan. 1996 and Dec. 2004, included 24,598 adults, of whom 51.4 percent (n = 12,648) initiated statin therapy. There was a median of 2.4 years of follow-up, during which 8,235 patients died.
The researchers found that new statin use was associated with a 24 percent lower relative risk of death (14.5 deaths per 100 person-years [the number of people in the study times the number of years of follow-up per person]) compared with not taking a statin (25.3 deaths per 100 person-years), even after adjustment for cholesterol level, use of other cardiovascular medications, and other factors. Similarly, new statin use was associated with a 21 percent lower relative risk of hospitalization for heart failure compared with no statin use. The lower rate of death and hospitalization was seen in the presence or absence of known coronary heart disease.
“… given the clinically relevant effect size associated with receipt of statins in our study, results from ongoing and future randomized controlled trials involving clinical outcomes—particularly among patients with nonischemic heart failure not otherwise recommended to receive lipid-lowering therapy—are needed to clarify the role of statins in the management of heart failure,” the authors conclude.
(JAMA. 2006;296:2105-2111. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The research for this article was funded by a grant from Amgen Inc. Dr. Go and co-author Jingrong Yang, M.A., reported receiving research support for this study from Amgen Inc. Dr. Go also reported receiving research support from Wyeth. Co-author Joan C. Lo, M.D., reported receiving research support from Novartis. None of the other authors reported disclosures. 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 31, 2006
Media Advisory: To contact David S. Paterson, Ph.D., call Alissa Rooney at 617-355-6420. To contact editorial author Debra Ellyn Weese-Mayer, M.D., call Mary Ann Schultz at 312-942-7816.
BRAINSTEM ABNORMALITY LINK TO SIDS STRONGER THAN PREVIOUSLY INDICATED—FINDINGS MAY PROVIDE CLUES TO EXPLAIN WHY BOYS ARE MORE VULNERABLE TO SIDS
CHICAGO—Preliminary research suggests that brainstem abnormalities involving certain serotonin pathways in the brain may play a more important role in SIDS than previously thought, according to an article in the November 1 issue of JAMA.
Sudden infant death syndrome (SIDS) is the leading cause of postneonatal infant death in the United States. Despite intensive research, the causes of SIDS remain unknown, according to background information in the article. Previous research has suggested that abnormalities in the receptor (a structure on the surface or inside a cell) binding of the serotonergic (5-hydroxytryptamine [5-HT]) neurons in the medulla (the section of the brainstem that regulates breathing) may play a role in SIDS.
David S. Paterson, Ph.D., of Children’s Hospital Boston and Harvard Medical School, Boston, and colleagues examined the relationship between SIDS cases and cellular defects associated with altered 5-HT receptor binding in the 5-HT pathways in the medulla of the brain. The researchers analyzed frozen samples of the medulla from 31 infants who died from SIDS (cases) and from 10 infants who died from causes other than SIDS (controls). The brain tissues were obtained from the San Diego Medical Examiner’s office between 1997 and 2005. Markers of 5-HT function were compared between SIDS cases and controls. The number of samples available for each analysis ranged from 16 to 31 for SIDS cases and 6 to 10 for controls. An exploratory analysis of the correlation between markers of HT function and 6 recognized risk factors for SIDS also was performed.
“We found that the medullary 5-HT abnormalities in SIDS are more extensive than previously suggested and that they involve multiple elements of 5-HT function, including 5-HT neuron count, 5-HT1A receptor expression, and relative 5-HT transporter binding in the same cases. This study strengthens the hypothesis that medullary 5-HT dysfunction is associated with SIDS and may lead to death by a failure of respiratory and autonomic responses [functions of the nervous system not under voluntary control, e.g. the regulation of heartbeat or gland secretions] to homeostatic [internal regulatory] stressors during sleep,” the authors write.
“This study also found, in an explanatory analysis, reduced 5-HT1A receptor binding density in male compared with female SIDS cases, an observation that may help explain why males are more vulnerable to SIDS. These 5-HT abnormalities were documented during the era of stringent public messages on risk reduction, including that for supine sleep position. The majority (65 percent) of the SIDS cases in this data set, however, were sleeping prone or on their side at the time of death, indicating the need for continued public health messages on safe sleeping practices.”
The researchers speculate that the increased risk of SIDS in the prone or face-down position may reflect the infants’ inability to respond to the challenge to breathe in the face-down position, due to the abnormalities in the medullary 5-HT system that compromise protective reflexes, including arousal and head turning.
“This study provides biological plausibility for certain risk reduction strategies in SIDS …,” the authors write. “Moreover, it generates new hypotheses for testing about 5-HT–related brainstem pathology underlying sudden death in early life in future SIDS autopsies and in experimental mechanistic models.”
(JAMA. 2006;296:2124-2132. 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.
EDITORIAL: SUDDEN INFANT DEATH SYNDROME—IS SEROTONIN THE KEY FACTOR?
In an accompanying editorial, Debra Ellyn Weese-Mayer, M.D., of Rush University Medical Center, Chicago, examines the findings of the study in this week’s JAMA on SIDS.
“Recognizing that 5-HT influences a broad range of physiological systems including the regulation of breathing, the cardiovascular system, temperature, and the sleep-wake cycle, the study by Paterson et al extends the available literature in support of the underlying hypothesis that SIDS is the result of 5-HT–mediated dysregulation of the autonomic nervous system.”
“While the neuropathological studies in SIDS are providing remarkable insight into the underlying mechanisms in the 5-HT pathways, identification of the definitive cause for SIDS will necessitate an expanded network of scientists and families working together toward the shared goal. They can join forces to influence legislation in their own states to replicate the success of the California program. Likewise, clinicians and researchers can gently inform parents who have lost an infant to SIDS about autopsy and the opportunity for their lost infant to contribute to the further understanding of SIDS. With 2,162 infants dying from SIDS in the United States in 2003, there is no time to lose in determining if serotonin is the key factor in the pathophysiology of SIDS.”
(JAMA. 2006;296:2143-2144. 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.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
‘CONSTRAINT-INDUCED MOVEMENT THERAPY’ IMPROVES HAND-ARM FUNCTION IN SOME STROKE PATIENTS BY UP TO 65% COMPARED TO USUAL CARE'
VIDEO:
B-ROLL
NAT SOT UP FULL FOR :03
Therapist timing patient
AUDIO:
THIS IS CONSTRAINT-INDUCED MOVEMENT THERAPY, WHICH FORCES STROKE PATIENTS TO USE THEIR WEAKER HAND BY WEARING A MITT ON THEIR GOOD HAND.
VIDEO:
SOT/FULL
@ :11
Super: Steve Staton
Stroke survivor
Runs :12
AUDIO:
“The constraint therapy with the mitt is a visual reminder and a physical reminder that, you know, do not default to the unaffected hand.”
VIDEO:
B-ROLL
Theodore using calculator – different angle
Steve performing tasks – different angle
GFX/JAMA COVER
AUDIO:
YEARS AFTER THEIR THERAPY, THESE MEN ARE STILL DOING WELL. BUT DOES THIS THERAPY WORK BETTER THAN TRADITIONAL TREATMENTS? THE ANSWER IS YES, ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
@ :34
Super: Steven Wolf, Ph.D., P.T
Emory University
Runs :12
AUDIO:
“We believe that this study justified providing more constraint-induced movement therapy both in the clinic and the home environment.”
VIDEO:
B-ROLL
Bite runs through name
Exterior/sign “Center for Rehabilitation Medicine”
Dr. Wolf with Steve and therapist
C/u on hand (not mitt) doing task
Theodore using calculator –mitt is in shot when narration says “wore the mitt”
Theodore with therapist
AUDIO:
DR. STEVEN WOLF OF EMORY UNIVERSITY’S CENTER FOR REHABILITATION MEDICINE IS ONE OF THE STUDY AUTHORS. THEY STUDIED MORE THAN TWO-HUNDRED STROKE PATIENTS AT SITES ACROSS THE COUNTRY. EACH PATIENT HAD HAD A STROKE THREE-TO-NINE MONTHS PRIOR TO TREATMENT, BUT DID HAVE A LITTLE MOVEMENT IN THEIR AFFECTED HAND. ABOUT HALF THE PATIENTS GOT CONSTRAINT-INDUCED, OR C-I THERAPY. THEY WORE THE MITT FOR TWO WEEKS, WORKING WITH A PHYSICAL THERAPIST SIX HOURS A DAY. THE REST OF THE PATIENTS RECEIVED TRADITIONAL TREATMENTS.
VIDEO:
SOT/FULL
Steven Wolf, Ph.D., P.T.
Emory University
Runs :18
AUDIO:
“We found a 24% improvement in the amount of activity the patients receiving C.I. therapy could do in 30 different tasks, and a 65% improvement in the quality of the movement.”
VIDEO:
B-ROLL
Steve performing tasks quickly
Theodore opening yogurt lid
AUDIO:
PATIENTS WHO GOT THE C-I THERAPY WERE ABLE TO COMPLETE TASKS MORE QUICKLY, TOO. AND THE IMPROVEMENTS WERE STILL THERE A YEAR LATER. THIS STROKE SURVIVOR SAYS IT’S AS SIMPLE AS THIS:
VIDEO:
SOT/FULL
@ 1:40
Super: Theodore Augustus
Stroke survivor
Runs :09
AUDIO:
“If you’ve had a stroke, if you have feeling at all in your hand, if you don’t use it, you’ll lose it.”
VIDEO:
B-ROLL
Theodore eating yogurt
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
