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, December 5, 2006)
JAMA NEWS RELEASES
FIRST-TIME MOTHERS AT INCREASED RISK FOR POSTPARTUM MENTAL DISORDERS
WHOLE-BODY SCANS MAY PROVIDE OPTION FOR DIAGNOSING COLORECTAL CANCER
PHARMACY CARE PROGRAM HELPS ELDERLY PATIENTS TAKE ALL THEIR MEDICATIONS (Previously Released Online)
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
PHARMACY CARE PROGRAM RAISES ELDERLY MEDICATION ADHERENCE TO NEARLY 100 PERCENT
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 effect of a pharmacy care program on medication adherence and blood pressure and cholesterol levels. The report will be fed Tuesday, December 5, 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, December 5, 2006
Media Advisory: To contact Trine Munk-Olsen, M.Sc., email: tmo{at}ncrr.dk. To contact editorial co-author Katherine L. Wisner, M.D., M.S., call Jocelyn Duffy at 412-647-3555.
FIRST-TIME MOTHERS AT INCREASED RISK FOR POSTPARTUM MENTAL DISORDERS
CHICAGO—New mothers are at an increased risk for mental disorders such as schizophrenia, depression and bipolar disorder in the 3 months following the birth of their first child, according to a study in the December 6 issue of JAMA. The study also found that first-time fathers do not have an increased risk for mental disorders.
Postpartum depression is a serious mental health problem for women and their families, with an estimated prevalence of about 10 percent to 15 percent among mothers. Postpartum disorders can also include more severe mental disorders, with a prevalence of about 1 per 1,000 births, according to background information in the article. There is some indication that a small percentage of men experience postpartum depression, but the possible relationship between becoming a father and first onset of mental disorders has not been established.
Trine Munk-Olsen, M.Sc., of the University of Aarhus, Denmark and colleagues conducted a study to estimate the risk of postpartum mental disorders requiring hospital admission or outpatient contact for first-time mothers and fathers up to 12 months after becoming a parent. The researchers analyzed data from Danish health and civil service registers, which for this study included a total of 2,357,942 Danish-born persons who were followed up from their 15th birthday or January 1973, whichever came later, until date of onset of the disorder in question, date of death, date of emigration from Denmark, or July 2005, whichever came first.
From 1973 to 2005, a total of 630,373 women and 547,431 men became parents for the first time. A total of 1,171 women and 658 men were admitted with a mental disorder to a psychiatric hospital during the first 12 months after parenthood, and the corresponding prevalence of severe mental disorders through the first 3 months after childbirth was 1.03 per 1,000 births for mothers and 0.37 per 1,000 births for fathers. For first-time mothers, the first weeks and months after the delivery were associated with an increased risk of first admission with any mental disorder, and the period from 10 to 19 days following the birth was associated with the highest risk (7.3 times increased risk) compared with women who had given birth 11 to 12 months previously. The increased risk of admission among mothers remained statistically significant through the first 3 months after childbirth regardless of age of the mother. Risk for mothers was also increased for psychiatric outpatient contacts through the first 3 months after childbirth, also with the highest risk occurring 10 to 19 days following the birth.
Unlike motherhood, fatherhood was not associated with any increased risk of hospital admission or outpatient contact. “This may indicate that the causes of postpartum mental disorders are more strongly linked to an altered physiological process related to pregnancy and childbirth than psychosocial aspects of motherhood.”
“Accurate estimates of the rates of and risk factors for postpartum depression are highly important for the scientific and clinical understanding of mental and behavioral disorders during the postpartum period as well as for planning mental health services for childbearing women and their families,” the authors write.
(JAMA. 2006;296:2582-2589. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Stanley Medical Research Institute, Chevy Chase, Md. Psychiatric epidemiological research at the National Centre for Register-Based Research is in part funded through a collaborative agreement with the Centre for Basic Psychiatric Research, Psychiatric Hospital, Aarhus, Denmark. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: POSTPARTUM DEPRESSION — A MAJOR PUBLIC HEALTH PROBLEM
In an accompanying editorial, Katherine L. Wisner, M.D., M.S., of the University of Pittsburgh Medical Center, and colleagues comment on the findings concerning postpartum depression.
“These collective data [Munk-Olsen et al and other studies] emphasize the importance of recognizing childbearing as a potent health factor in the life course of women. Childbearing influences the course of any disease state and acts as a biopsychosocial factor that may precipitate new episodes of illness. The data also provide evidence to inform and support universal screening for postpartum mood episodes. The studies converge on the time frame of elevated risk for both hospitalization and outpatient contacts as the first 3 months postpartum, particularly in primiparae [first birth], independent of considerations of diagnosis,” they write. “Therefore, screening should be implemented as early as 2 weeks after delivery and no later than 12 weeks postpartum to identify episodes of major mood disorder and other mental illnesses.”
“Effective treatments for these episodes exist. Rapid implementation of treatment is prudent because mood episodes can be lengthy and psychosocial sequelae increase with duration. Maternal depression exacts a heavy toll on women’s functioning and the health and well-being of their children. … Mental health is crucial to a mother’s capacity to function optimally, enjoy relationships, prepare for the infant’s birth, and cope with the stresses and appreciate the joys of parenthood.”
(JAMA. 2006;296:2616-2618. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the editorial 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, December 5, 2006
Media Advisory: To contact corresponding author Gerald Antoch, M.D., email: gerald.antoch{at}uni-duisburg-essen.de.
WHOLE-BODY SCANS MAY PROVIDE OPTION FOR DIAGNOSING COLORECTAL CANCER
CHICAGO—Preliminary research suggests that whole-body PET and CT scans could provide a suitable method for diagnosing the stage of colorectal cancer, according to a study in the December 6 issue of JAMA.
Colorectal cancer accounts for a large number of tumor-related deaths. Exact and complete information on the stage of the tumor is of great benefit to patients, according to background information in the article. Determining the stage of colorectal cancer often requires a multimodality, multistep imaging approach. Complete “conventional” staging determination requires additional imaging procedures to assess potential metastatic spread to lymph nodes and solid organs. Colonography combining the imaging procedures of positron emission tomography (PET) and computed tomography (CT) provides whole-body tumor staging in a single session.
Of conventional imaging procedures, contrast-enhanced CT is the most common for both the abdomen and the thorax. However, CT offers only form and structure data for the evaluation of the tumor stage. Combined PET/CT scanners have been introduced into clinical practice to provide additional information on a tumor. By performing PET/CT colonography as a whole-body imaging procedure, multimodality diagnostic workup can be shortened.
Patrick Veit-Haibach, M.D., of University Hospital Essen, Germany, and colleagues evaluated the diagnostic accuracy of whole-body PET/CT colonography for 47 patients with colorectal cancer and compared those findings with the accuracy of conventional CT staging alone and CT followed by PET (CT + PET). Patients with clinical findings and optical colonoscopy that suggested primary colorectal cancer were enrolled between May 2004 and June 2006. Patients underwent whole-body PET/CT colonography 1 day after colonoscopy. Fifty lesions were detected in the 47 patients.
Based on a lesion-to-lesion analysis, TNM stage (different classifications of tumor stage) was correctly determined by PET/CT colonography in 37 (74 percent) of 50 lesions and by CT alone in 26 (52 percent) of 50 lesions at a certain threshold of measurement. With CT + PET, TNM was correctly determined in 32 (64 percent) of 50 lesions. Compared with optimized abdominal CT staging alone, PET/CT colonography was more accurate in defining TNM stage (difference, 22 percent), which was mainly based on a more accurate definition of the T-stage.
Of the 47 patients, PET/CT colonography changed the therapy management in 4 (9 percent) compared with conventional staging. The change in patient management was based either on a more accurate assessment of the tumor stage of colorectal cancer or on accompanying findings on PET/CT colonography.
“In addition to optical colonoscopy, whole-body PET/CT colonography as an all-in-one staging modality seems feasible to provide an alternative to the multimodality, multistep staging in patients with colorectal cancer. … It is less time-consuming than a conventional multistep approach with CT alone (abdomen and thorax) and PET imaging if required. Thus, it represents a psychological and physical advantage when considering the burden to the patient of different imaging procedures. The referring physician will receive a single report including complete tumor staging in a single step, enabling him/her to define further therapy,” the authors write.
“This preliminary report suggests that PET/CT colonography may be at least equivalent to CT + PET with respect to tumor staging in patients with colorectal cancer. The reason for a change in patient management with PET/CT colonography compared with a conventional staging concept must be attributed partially to the detection of synchronous [existing at the same time] tumors rather than to a more accurate TNM staging of colorectal cancer. Because an all-in-one staging modality has to offer both accurate TNM staging of the tumor in question and information on potentially present synchronous tumors, PET/CT colonography in conjunction with optical colonoscopy may be suitable for whole-body all-in-one tumor staging in patients with colorectal cancer,” the researchers conclude.
(JAMA. 2006;296:2590-2600. 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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For Immediate Release
Media Advisory: To contact corresponding author Allen J. Taylor, M.D., call Walter Reed Army Medical Center public affairs at 202-782-7177. To contact editorial author Ross J. Simpson, Jr., M.D., Ph.D., call Stephanie Crayton at 919-966-2860.
PHARMACY CARE PROGRAM HELPS ELDERLY PATIENTS TAKE ALL THEIR MEDICATIONS
CHICAGO—A pharmacy care program for elderly patients increases medication adherence, which results in improved health outcomes, according to a study in the December 6 issue of JAMA. The study was posted online November 13 to coincide with its presentation at the American Heart Association Scientific Session.
“Adherence to chronic pharmacological therapies is poor, leading to worsening disease severity and increased costs associated with higher hospital admission rates,” the authors provide as background information. “Barriers to medication adherence are numerous, but include the prescription of complex medication regimens, treatment of asymptomatic conditions and convenience factors. These factors are particularly prevalent among the elderly population, placing them at increased risk for medication nonadherence.”
Jeannie K. Lee, Pharm.D., and colleagues from Walter Reed Army Medical Center, Washington, D.C., report the results from the Federal Study of Adherence to Medications in the Elderly (FAME), a multi-phase investigation that included 200 community-based patients age 65 years or older taking at least four chronic medications. The FAME study, which was conducted from June 2004 to August 2006 consisted of three phases. First, all 200 patients entered a two-month run-in phase that provided a baseline for medication adherence using pill counts, and for blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) readings. Of these patients, 174 then entered a six-month intervention phase that included standardized medication education, regular follow-up by pharmacists and all medications dispensed in time-specified blister packs. Following the intervention phase, 159 patients were randomized to continue the pharmacy care program or return to their usual care for an additional six months.
The average age of the study patients was 78 years. Cardiovascular risk factors were prevalent and included drug-treated hypertension in 184 patients (91.5 percent) and drug-treated hyperlipidemia in 162 patients (80.6 percent). The patients took an average of nine different chronic daily medications. At the beginning of the first phase of the study, the researchers found the average medication adherence was 61.2 percent. “After six months of intervention, medication adherence increased to 96.9 percent and was associated with significant improvements in systolic blood pressure (133.2 to 129.9 millimeters of mercury) and LDL-C (91.7 to 86.8 milligrams per deciliter),” the researchers report. “Six months after randomization, the persistence of medication adherence decreased to 69.1 percent among those patients assigned to usual care, whereas it was sustained at 95.5 percent in pharmacy care.” The pharmacy care group also had significant reductions in systolic blood pressure compared to the usual care group, but no significant differences between the groups in LDL-C levels or reductions.
“In this study, a comprehensive pharmacy program composed of patient education and custom blister-packed medications was associated with substantial and sustained improvements in medication adherence among elderly patients receiving complex medication regimens. The association of improved medication adherence with reduced levels of BP and LDL-C suggests that such a program could lead to meaningful improvements in health outcomes. The results of the FAME study call for greater emphasis within health care delivery systems and policy organizations on the development and promotion of clinical programs to enhance medication adherence particularly among the at-risk elderly population,” the authors conclude.
(JAMA. 2006;296:2563-2571. Available 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: CHALLENGES FOR IMPROVING MEDICATION ADHERENCE
In a related editorial, Ross J. Simpson Jr., M.D., Ph.D., from the University of North Carolina at Chapel Hill writes “for chronic medical conditions, such as hypercholesterolemia and hypertension, a wide and persistent separation exists between evidence-based recommendations and the actual care patients receive.”
“Patient characteristics that may lead to poor adherence include advanced age, cognitive impairment and depression as well as attitudes and beliefs about the importance of the medication, the disease being treated and the potential for adverse effects.”
“...the study by Lee and colleagues adds important information about improving medication adherence in elderly patients and also highlights the challenges inherent in designing and conducting high-quality research in this critically important area. Multifaceted interventions that incorporate structural and counseling components and include appropriately skilled and motivated pharmacists appear useful to promote medication adherence and persistence. Future studies are needed to confirm that interventions incorporating these components will result in increased and sustained patient adherence and, better yet, will improve outcomes.”
(JAMA. 2006:296:2614-2616. Available to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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
PHARMACY CARE PROGRAM RAISES ELDERLY MEDICATION ADHERENCE TO NEARLY 100 PERCENT
VIDEO:
NAT SOT UP FULL FOR :06
Pharmacist explaining chart to patient
AUDIO:
“That’s for cholesterol, 20 milligrams, and that’s one tablet in the evening time.”
VIDEO:
B-ROLL
Wide shot of pharmacist explaining chart to patient
AUDIO:
THIS PHARMACIST IS EXPLAINING MEDICATIONS TO 92-YEAR OLD BIRDIE GELFER.
VIDEO:
SOT/FULL
@ :11
Super: Birdie Gelfer
92 years old
Runs : 06
AUDIO:
“I take 15 doses of pills every day, some I take twice a day.”
VIDEO:
B-ROLL
Pharmacist loading pills into each blister pack
Exterior Walter Reed
Backtime bite starting at “Taylor”
AUDIO:
KEEPING THEM ALL STRAIGHT AND REMEMBERING WHAT TO TAKE WHEN IS NO EASY TASK. BUT IT WAS MADE EASIER BY A PILOT PROGRAM AT WALTER REED ARMY MEDICAL CENTER, SPEARHEADED BY DR. ALLEN TAYLOR.
VIDEO:
SOT/FULL
@ :28
Super: Allen Taylor, M.D.
Walter Reed Army Medical Center
Runs:14 edit covered @ “and then”-pharmacy video
AUDIO:
“There’s a chain of responsibility here. The doctor to pick the right pill, the patient to be willing to take the pill and understand the pill, and then the medical care system to deliver that pill in way that’s convenient.”
VIDEO:
B-ROLL
Dr. Taylor talking with colleagues
Pharmacist handing Birdie blister packs
Explaining blister packs to Birdie
Discussing blister packs
GFX/JAMA COVER
AUDIO:
SO HE AND HIS COLLEAGUES CREATED A PHARMACY CARE PROGRAM WITH PATIENT EDUCATION, FOLLOW-UP WITH THE PATIENTS, AND THESE CONVENIENT, INDIVIDUALIZED BLISTER PACKS CONTAINING ALL THEIR PILLS AND INSTRUCTIONS WHEN TO TAKE THEM. RESEARCHERS MEASURED MEDICATION ADHERENCE RATES IN ELDERLY PEOPLE BEFORE THEY ENTERED THE PROGRAM, AND AGAIN WHEN THEY WERE IN THE PROGRAM. THE FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
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Allen Taylor, M.D.
Walter Reed Army Medical Center
Runs : 09
AUDIO:
“In the study we found that medication adherence improved from 61 % before the program to over 96%.”
VIDEO:
B-ROLL
Pan/close up of blister packs with pills
Pharmacist taking Birdie’s blood pressure
AUDIO:
AND PEOPLE GOT HEALTHIER TOO. MOST OF THE TWO-HUNDRED ELDERLY PEOPLE IN THE STUDY TOOK MEDICATIONS TO LOWER THEIR BLOOD PRESSURE AND CHOLESTEROL. WHILE IN THE PHARMACY CARE PROGRAM, THEIR BLOOD PRESSURE AND CHOLESTEROL LEVELS IMPROVED.
VIDEO:
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Allen Taylor, M.D.
Walter Reed Army Medical Center
Runs : 08
AUDIO:
“If we can find ways not to just develop good pills but then find ways that they’re taken most effectively, patients’ lives and outcomes will be better.”
VIDEO:
B-ROLL
Backtime
AUDIO:
BIRDIE LOVED THE PROGRAM.
VIDEO:
SOT/FULL
Birdie Gelfer
92 years old
Runs : 12
Edit covered - Latter part of bite covered with Birdie holding packs, pushing pills through blister pack
AUDIO:
“Because they took all the worrying of remembering and fussing with the vials.”
“All you do is go to your card, punch out what you need for that period.”
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B-ROLL
Birdie holding pills
Birdie taking/swallowing pills
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SHE WISHES IT WASN’T JUST A PILOT PROGRAM, AND THAT EVERYONE COULD HAVE THIS KIND OF PHARMACY CARE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
