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 of 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 CONTENTS
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 1, 2007)
PRENATAL MULTIVITAMINS FOR UNDERNOURISHED WOMEN MAY REDUCE RISK OF LOW BIRTH WEIGHT
HEALTH CARE EXPENDITURES SIGNIFICANTLY HIGHER FOR CHILDREN WITH OBESITY
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 1, 2007)
PTSD MAY INCREASE HEART DISEASE RISK IN OLDER MEN
PATIENTS WITH PTSD EXPERIENCE LESS PAIN SENSITIVITY; MAY BE RELATED TO ALTERED PROCESSING
CHILD ABUSE AND NEGLECT ASSOCIATED WITH INCREASED RISK OF DEPRESSION AMONG YOUNG ADULTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 1, 2007
Media Advisory: To contact Piyush Gupta, M.D., M.A.M.S., e-mail: drpiyush{at}satyam.net.in. To contact corresponding editorialist Gary L. Darmstadt, M.D., M.S., call Kenna Lowe at 410-614-6029.
PRENATAL MULTIVITAMINS FOR UNDERNOURISHED WOMEN MAY REDUCE RISK OF LOW BIRTH WEIGHT
CHICAGO—Undernourished women who take a vitamin and mineral supplement while pregnant may be less likely than women taking only iron and folic acid supplements to have babies weighing less than 2,500 grams, and their newborns may be less likely to have morbidity in the first seven days of life, according to a report in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Low birth weight, or a weight of less than 2,500 grams, is a major predictor of death in infancy, according to background information in the article. It also increases the risk that the child will grow up to develop coronary heart disease, type 2 diabetes, stroke or high blood pressure. In countries low on resources, a mother’s nutrition before and during pregnancy are known to affect the birth weight of her baby. Low-income women are often deficient in a number of micronutrients (vitamins and minerals), including vitamins C and E, vitamin B complex and folate.
Piyush Gupta, M.D., M.A.M.S., University College of Medical Sciences, Delhi, India, and colleagues conducted a randomized trial involving 200 women who were 24 to 32 weeks pregnant and either underweight (having a body mass index of less than 18.5) or with a low hemoglobin level (between 7 and 9 grams per deciliter), which can indicate malnourishment. The women all lived within 5 kilometers of a hospital in East Delhi, India, and planned to deliver either at the hospital or in the neighborhood. Information about the participants, including age, height and pre-pregnancy weight, was collected at the hospital between May 1, 2002, and April 30, 2003.
One hundred and one of the women were randomly assigned to take a placebo tablet containing only calcium, and the other 99 received a tablet containing a mix of 29 micronutrients and were instructed to take it daily. Both groups were given iron and folic acid supplements and guidance on prenatal health and were monitored during regular prenatal clinic visits. If the baby was born at the hospital, information about the delivery, birth weight and health of the child was collected there; otherwise, the mothers were contacted personally and asked for this information. Newborns at the hospital were followed up for seven days to detect any evidence of congenital abnormalities or other conditions or illnesses.
Women in the micronutrient group gained an average of 9.2 kilograms (20.3 pounds) during their pregnancies, compared with 8.7 kilograms (19.2 pounds) in the placebo group. Of the 200 babies born, 146 were included in the analysis of birth size and 170 (88 in the micronutrient group and 82 in the placebo group) in the analysis of death or illness within seven days. After the researchers adjusted for other factors that affect birth weight, babies whose mothers took micronutrients weighed an average of 98 grams more and were .8 centimeters longer. Rate of low birth weight was 43.1 percent in the placebo group vs. 15.2 percent among those on micronutrient supplements. Four infants died in each group.
“Our findings are of a preliminary nature and need to be further corroborated,” the authors write. “We advocate community-based trials in deprived populations to ascertain the impact of a supplementation schedule lasting throughout pregnancy. The sample size should be large enough to evaluate the effect of such supplementation on neonatal morbidity and mortality, in addition to the size at birth.”
(Arch Pediatr Adolesc Med. 2007;161:58-64. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The study drugs were supplied by Ranbaxy India Ltd. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: INTEGRATED APPROACH NEEDED TO SAVE NEWBORN LIVES
“Neonatal deaths are traditionally viewed by child survival programs as relatively difficult to prevent, but new studies are strengthening the limited evidence base for highly cost-effective interventions that can save newborn lives in developing countries,” write Rachel A. Haws, M.H.S., and Gary L. Darmstadt, M.D., M.S., of Bloomberg School of Public Health, Johns Hopkins University, Baltimore, in an accompanying editorial.
“As researchers build the evidence base for cost-effective interventions, policy makers, researchers and program managers must collaborate with donors, governments and nongovernmental organizations to invest fully and long-term in integrated maternal, newborn and child health strategies,” they write.
“We must also commit to equity and human rights by addressing the political, economic and social sources of inequality to which so many deaths and suffering can be attributed, not least by capacity building at all levels; collecting effectiveness data; and ensuring appropriate compensation and oversight for health care professionals, from community health workers to obstetric surgeons, working within these systems,” they conclude.
(Arch Pediatr Adolesc Med. 2007;161:99-102. Available to the media pre-embargo at www.jamamedia.org).
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 1, 2007
Media Advisory: To contact Sarah E. Hampl, M.D., call Wandra Green at 816-235-1601.
HEALTH CARE EXPENDITURES SIGNIFICANTLY HIGHER FOR CHILDREN WITH OBESITY
CHICAGO—Children and adolescents who are obese or overweight have higher health care utilization and a significantly higher average of health care charges than their healthy-weight peers, according to a report in the January issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
According to background information in the article, 30 percent of children in the United States are obese or overweight with six in ten having at least one risk factor for cardiovascular disease and 25 percent having more than two risk factors for the disease. The authors note that more than 80 percent of obese 12-year-olds will carry their overweight status into adulthood.
Sarah E. Hampl, M.D., and colleagues at the University of Missouri–Kansas City School of Medicine analyzed data from 8,404 patients age 5 to 18 who attended a primary care clinic in the Midwest for well-child care visits during 2002 and 2003. Body mass index (BMI) was calculated with patients’ height and weight information. Four weight categories were used in the study: patients with a BMI in the 95th percentile or higher for their age and sex with a discharge diagnosis of obesity, patients with a BMI in the 95th percentile or higher for their age and sex without a diagnosis of obesity, patients with BMI between the 85th and 94th percentiles classified as overweight and patients with BMIs lower than the 85th percentile classified as healthy weight.
Health care resource utilization was measured for each category and included the number of health care visits and blood tests that occurred within a year from each patient’s initial visit. Health care expenditures were determined by charge data obtained through the billing system of health care resources. Factors associated with the diagnosis of obesity were also examined.
Based on the patients’ BMI, 17.8 percent were overweight and 21.9 percent were obese. Of the obese children, only 42.9 percent had a discharge diagnosis of obesity, suggesting a significant rate of underdiagnosis. “When obesity was present, being female, older and insured by Medicaid were associated with a higher probability of having diagnosed obesity,” the authors write.
A significantly higher rate of utilization of laboratory services by overweight and obese children was found when compared to their healthy-weight peers. This increase was most notable for children with diagnosed obesity. “We speculate that this increase reflects primary care provider compliance with expert committee recommendations for laboratory evaluation of obese children and adolescents,” the authors write. “Compared with their healthy-weight peers, children with overweight, diagnosed obesity and undiagnosed obesity had significantly higher charges, with the highest for the diagnosed obesity category,” with an average adjusted difference of $172.
“This finding is perhaps reflective of primary care provider intent to detect and treat comorbid conditions. This trend of increased health care utilization, observed even in children younger than 10 years, is similar to the trends seen in adult patients,” the authors conclude. “Efforts to continue to educate primary care providers regarding the diagnosis of obesity and early interventions to address obesity in children are warranted.”
(Arch Pediatr Adolesc Med. 2007;161:11-14. Available to the media pre-embargo 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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 1, 2007
Media Advisory: To contact Laura D. Kubzansky, Ph.D., call Todd Datz at 617-432-3952.
PTSD MAY INCREASE HEART DISEASE RISK IN OLDER MEN
CHICAGO—A higher level of symptoms of posttraumatic stress disorder may increase the risk of coronary heart disease in older men, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
A link between stress and coronary heart disease (CHD) has long been proposed. Numerous studies have found that cardiovascular disease and its risk factors are more common among individuals with posttraumatic stress disorder (PTSD), according to background information in the article. But to the authors’ knowledge, no prospective studies to date have examined PTSD in relation to CHD risk.
Laura D. Kubzansky, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a prospective study to test the hypothesis that high levels of PTSD symptoms may increase CHD risk, using two different measures of PTSD (the Mississippi Scale for Combat-Related PTSD and the Keane PTSD scale). The authors analyzed data on 1,946 men enrolled in the Veterans Affairs Normative Aging Study. All the study subjects were community-dwelling men from the Greater Boston area who served in the military. The authors looked for incident (new cases) of coronary heart disease occurring during follow-up through May 2001.
Using the Mississippi Scale for Combat-Related PTSD, the authors found that for each increase in symptom level, the men had a 26 percent increased risk for non-fatal heart attack and fatal CHD combined. They had a 21 percent increased risk for all CHD outcomes combined (non-fatal heart attack, fatal CHD, and angina). The findings were replicated using the Keane PTSD scale.
“This pattern of effects suggests that individuals with higher levels of PTSD symptoms are not simply prone to reporting higher levels of chest pain or other physical symptoms but may well be at higher risk for developing CHD,” the authors write.
“These data suggest that prolonged stress and significant levels of PTSD symptoms may increase the risk for CHD in older male veterans,” they conclude. “These results are provocative and suggest that exposure to trauma and prolonged stress not only may increase the risk for serious mental health problems but are also cardiotoxic.”
(Arch Gen Psychiatry. 2007;64:109-116. Available to the media pre-embargo 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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 1, 2007
Media Advisory: To contact Elbert Geuze, Ph.D., e-mail: s.g.geuze{at}umcutrecht.nl.
PATIENTS WITH PTSD EXPERIENCE LESS PAIN SENSITIVITY; MAY BE RELATED TO ALTERED PROCESSING
CHICAGO—Patients with posttraumatic stress disorder show reduced pain sensitivity, a pattern that may be related to altered pain processing in the brain, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Posttraumatic stress disorder (PTSD) is an anxiety disorder that may occur in individuals exposed to a traumatic event. It is characterized by chronic arousal, re-experience of the event, and avoidance of stimuli related to the event, according to background information in the article. To the authors’ knowledge, no functional imaging study has explored whether patients with PTSD experience and process pain in a different way than control subjects.
Elbert Geuze, Ph.D., of Central Military Hospital and the Rudolph Magnus Institute of Neuroscience, Utrecht, the Netherlands, and colleagues conducted a study to examine neural correlates of pain processing in patients with PTSD. Twelve male Dutch veterans with PTSD and 12 male veterans without PTSD were recruited and matched for age, region of deployment and year of deployment. The experimental procedure consisted of psychophysical assessment and neuroimaging with functional magnetic resonance imaging (fMRI)—the use of magnetic resonance imaging to learn which regions of the brain are active in a specific function. During fMRI, the patients rated the pain they experienced from fixed and variable temperatures applied to their hands.
“Patients with PTSD rated temperatures in the fixed-temperature assessment as less painful compared with controls,” the authors report.
“Before fMRI, patients with PTSD already showed a significant reduction in pain sensitivity,” the authors write. “During imaging, patients with PTSD rated a fixed temperature as significantly less painful than control veterans.”
Patients with PTSD showed altered pain processing in brain areas associated with mood and cognitive pain processing.
“These data provide evidence for reduced pain sensitivity in PTSD. The witnessed neural activation pattern is proposed to be related to altered pain processing in patients with PTSD,” the authors conclude.
(Arch Gen Psychiatry. 2007;64:76-85. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Dutch Ministry of Defense. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 1, 2007
Media Advisory: To contact Cathy Spatz Widom, Ph.D., call Chris Godek at 212-237-8628 or
Doreen Viñas at 212-237-8645.
CHILD ABUSE AND NEGLECT ASSOCIATED WITH INCREASED RISK OF DEPRESSION AMONG YOUNG ADULTS
CHICAGO—People who were abused and neglected during childhood have a higher risk of major depression when they become young adults, according to a report in the January issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Child abuse has been linked to depression in clinical populations and community surveys, according to background information in the article. But few prospective longitudinal studies have examined the relationship between abuse or neglect in childhood and depression in adulthood.
Cathy Spatz Widom, Ph.D., then of the New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, and now of John Jay College of Criminal Justice, New York, and colleagues conducted a prospective study to determine whether abused and neglected children were at elevated risk of major depressive disorder (MDD) and psychiatric illness, compared with matched control subjects, when followed up into young adulthood. The study included 676 children with substantiated cases of physical and sexual abuse and neglect before the age of 11. They were matched based on age, race, sex, and approximate family social class with 520 non-abused and non-neglected children. All were followed up into young adulthood (average age: 28.7).
“The current results show that childhood physical abuse was associated with increased risk for lifetime MDD,” the authors write. “We also provide new evidence that neglected children are at increased risk for depression as well.”
Child abuse and neglect were associated with a 51 percent increased risk for current MDD in young adulthood. Children who were physically abused had a 59 percent increased risk of lifetime MDD. Those who experienced multiple types of abuse had a 75 percent increased risk of lifetime MDD. The risk of current MDD was 59 percent higher for those who were neglected.
Childhood sexual abuse was not associated with an elevated risk of MDD. “However, childhood victims of sexual abuse reported significantly more depression symptoms than controls,” the authors point out.
“In addition, these findings reveal that onset of depression began in childhood for many of the children,” they write. “Our age-at-onset findings reinforce the need to intervene early in the lives of these abused and neglected children, before depression symptoms cascade into other spheres of functioning.”
(Arch Gen Psychiatry. 2007;64:49-56. Available to the media pre-embargo 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 JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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