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 INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 22, 2007)
EARLY RELEASE ARTICLE: RAPID FLU TESTING IS ASSOCIATED WITH DECREASED ANTIBIOTIC USE IN HOSPITALIZED ADULTS
DAILY USE OF ANTIDEPRESSANTS ASSOCIATED WITH INCREASED RISK OF FRACTURE IN OLDER ADULTS
REPEAT BONE MINERAL DENSITY SCANS DO NOT APPEAR HELPFUL FOR PREDICTING FRACTURES IN MOST OLDER WOMEN
SELENIUM SUPPLEMENTS MAY CONTRIBUTE TO REDUCED HIV VIRAL LOAD
HYPERTENSION CONTROL APPEARS BETTER IN U.S. THAN IN WESTERN EUROPE
PSYCHOSOCIAL FACTORS ASSOCIATED WITH HIGHER LEVELS OF INFLAMMATORY MARKERS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 22, 2007
Media Advisory: To contact Ann R. Falsey, M.D., call Michael Tedesco at 585-922-3677.
RAPID FLU TESTING IS ASSOCIATED WITH DECREASED ANTIBIOTIC USE IN HOSPITALIZED ADULTS
CHICAGO—Rapid influenza testing is associated with reductions in the use of antibiotics in hospitalized adults, according to a report posted online today that will appear in the February 26, 2007, print issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The study was posted online today because of its importance to public health.
New diagnostic tests are increasing the speed at which influenza and other viral diseases are identified, according to background information in the article. “The rapid diagnosis of influenza in hospital settings is important for infection control and potential antiviral therapy,” the authors write. When used in children with fevers, rapid tests for influenza viruses were shown to reduce the use of antibiotics and other diagnostic tests and shorten hospital stays. However, no similar studies have been done in adults.
Ann R. Falsey, M.D., and colleagues at Rochester General Hospital and University of Rochester School of Medicine and Dentistry, New York, reviewed the medical records of 166 patients with documented influenza hospitalized at their facility during four winters (1999 to 2003). Of these, 86 patients tested positive for influenza on rapid diagnostic testing and 80 either tested negative or did not receive the test.
Fewer patients with positive influenza test results were receiving antibiotics (86 percent or 74 out of 86 patients vs. 99 percent or 79 of 80 patients); 12 (14 percent) of 86 patients with positive results discontinued antibiotics vs. 2 (2 percent) of 80 patients without positive test results. After the researchers controlled for other variables, including underlying heart disease or other conditions, a positive rapid test result was independently associated with withholding or discontinuing antibiotic therapy.
“Although it is encouraging that antibiotic use was reduced in patients whose rapid antigen test result was positive, 61 percent (27/44) of those deemed at low risk for bacterial infection continued to receive antibiotics despite their rapid influenza diagnosis,” the authors write. “Patients who continued to receive antibiotics were more often older, were smokers with higher rates of underlying chronic obstructive pulmonary disease, and had abnormal lung examination results. These trends suggest that physicians were not indiscriminate with their therapy but rather responding to a perceived increased risk of bacterial infection in an older and frailer group.”
No significant differences were found between the two groups in the number of days taking antibiotics, the length of hospital stay or complications arising from antibiotics. Antiviral use was more common among those with positive test results (73 percent, or 63 out of 86 patients) than those with negative or no test results (8 percent, or six out of 80 patients).
Rapid diagnostic tests may affect not only the patient tested, but also lead to broader benefits, such as the reduction of nosocomial (hospital-acquired) influenza. “Given the environment of increasingly severe antibiotic-resistant nosocomial infections, control of inappropriate antibiotic use is highly desirable,” the authors write. “With ever more sophisticated tools … rapid accurate diagnosis for a wide number of viral pathogens will become available in the near future. To optimize use of these new diagnostic tools and limit antibiotic use in patients with viral infection, more accurate methods of diagnosing concomitant bacterial infections are needed.”
(Arch Intern Med. 2007;167:(doi:10.1001/archinternmed.167.4.ioi60207). Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the National Institutes of Health. Dr. Falsey serves on the advisory board for Quidel Inc., San Diego, Calif. 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 22, 2007
Media Advisory: To contact corresponding author David Goltzman, M.D., call Céline Poissant at 514-398-6751.
DAILY USE OF ANTIDEPRESSANTS ASSOCIATED WITH INCREASED RISK OF FRACTURE IN OLDER ADULTS
CHICAGO—Daily use of the antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs) by adults 50 years and older is associated with a doubled risk of some fractures, according to a report in the January 22, 2007 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Depression affects about 10 percent of primary care patients in the United States, according to background information in the article. The use of SSRIs for the treatment of depressive symptoms is widespread due to the medication’s presumed favorable adverse effect profile. Past studies have found the use of these antidepressants to be associated with an increased risk of clinical fragility fracture (fractures due to falling from bed, chair or standing height), but did not reliably examine such factors as falls and bone mineral density, the authors note.
J. Brent Richards, M.D., of McGill University, Montreal, Quebec, and colleagues evaluated 5,008 community-dwelling adults 50 years and older who were followed up for over five years for incident fractures. Researchers examined the relationships between SSRI use, bone mineral density (BMD) and falls. Participants who used the medication at the beginning of the study and at year five were considered to be recurrent users. BMD of the lower spine and hip were measured at the beginning of the study. Patients were then sent a yearly questionnaire to determine if they had experienced clinical fragility fractures and all reported fractures were confirmed radiographically. Other factors such as demographic information, history of falls and medication use were all assessed.
Daily use of SSRIs was reported by 137 participants with an average age of 65.1 years. The researchers found that “daily SSRI use remained associated with a two-fold increased risk of incident clinical fragility fracture even after adjustment for many potential confounding variables.” These fractures occurred at the forearm (40 percent), ankle and foot (21 percent), hip (13 percent), rib (13 percent) femur (9 percent) and back (4 percent). Participants who used SSRIs at the beginning of the study had similar increased risks of fracture to those who used them at follow-up.
During the initial interview, the daily use of SSRIs was associated with an increased risk of falling. The effect was dose-dependent; doubling the daily dose of SSRIs increased the odds of falling 1.5-fold during the previous month. Daily use of SSRIs was also associated with a 4 percent decreased BMD at the total hip and a 2.4 percent decrease at the lumbar spine.
“Our results suggest that BMD and falls may be affected adversely by daily SSRI use but that fracture rates remain elevated despite adjustment for these two risk factors, indicating that other pathways, such as impaired bone quality leading to reduced bone strength, may be of particular relevance,” the authors conclude. “In light of the high rate of SSRI use among the general population, and among elderly persons in particular, further studies that include controlled prospective trials are needed to confirm our findings.”
(Arch Intern Med. 2007;167:188-194. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The Canadian Multicentre Osteoporosis Study was funded by the Canadian Institutes of Health Research, Merck Frosst Canada, Ltd., Eli Lilly Canada Inc., Novartis Pharmaceuticals Inc., The Alliance for Better Bone Health (Sanofi-Aventis and Proctor & Gamble Pharmaceuticals Canada Inc.), The Dairy Farmers of Canada and The Arthritis Society. 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 22, 2007
Media Advisory: To contact Teresa A. Hillier, M.D., M.S., call Terry Fitzpatrick at 503-335-6602.
REPEAT BONE MINERAL DENSITY SCANS DO NOT APPEAR HELPFUL FOR PREDICTING FRACTURES IN MOST OLDER WOMEN
CHICAGO—Repeating a bone mineral density (BMD) scan up to eight years after an initial BMD appears to provide little additional benefit for predicting fractures among older postmenopausal women, according to a report in the January 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
BMD as measured by a method known as dual-energy x-ray absorptiometry helps physicians predict fractures and has become the gold standard for osteoporosis screening, according to background information in the article. Current guidelines recommend screening all women for osteoporosis using BMD measurements at age 65. However, there is little evidence supporting the use of repeat BMD testing for evaluating fracture risk, but such additional tests are commonly performed in clinical practice.
Teresa A. Hillier, M.D., M.S., of Kaiser Permanente Northwest/Hawaii, Portland, Ore., and colleagues measured total hip BMD in 4,124 older women (average age 72 years) in the Study of Osteoporotic Fractures between 1989 and 1990 and again an average of eight years later. The researchers calculated the rate of change in BMD and followed the women for an average of five years after the repeat BMD to see which women developed fractures. Participants were contacted by postcard every four months and fractures were verified through radiology reports and x-ray films.
During the follow-up period, 877 women had a non-traumatic non-spine fracture, including 275 hip fractures, and 340 women developed a spine fracture. On average, the women’s initial BMD measurements were low—compared to young women—but not in the osteoporotic range; the group lost an average of .59 percent of their bone mass per year between examinations. “In each of the four BMD models (initial BMD, repeat BMD, change in BMD between the two examinations, and initial BMD plus change in BMD), BMD was a significant predictor of incident non-spine and hip fracture risk, and was associated with morphometric spine fractures,” fractures in which the diagnosis is made based on vertebral shape, the authors write.
In the study, “we did not find any improvement in the overall predictive value … in a second measure of BMD, obtained a mean [average] of eight years later, in prediction of hip, spine or overall non-spine fracture risk,” they continue. “In other words, the initial BMD was highly, and similarly, predictive of fracture risk in our population.”
Despite these findings, a repeat BMD measurement might still be useful in some women, including those with clinical factors that contribute to rapid bone loss and younger women in early menopause. “However, our results do suggest that, for the average healthy older woman 65 years or older, a repeat BMD measurement has little or no value in classifying risk for future fracture—even for the average older woman who has osteoporosis by initial BMD measure or high BMD loss,” the authors conclude.
(Arch Intern Med. 2007;167:155-160. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and by Public Health Service grants from the National Institute on Aging. 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 22, 2007
Media Advisory: To contact Barry E. Hurwitz, Ph.D., call Jeannie Krull at 305-243-4853.
SELENIUM SUPPLEMENTS MAY CONTRIBUTE TO REDUCED HIV VIRAL LOAD
CHICAGO—Taking daily selenium supplements appears to increase the level of the essential mineral in the blood and may suppress the progression of viral load in patients with HIV infection, according to an article in the January 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Advances in antiretroviral therapy (ART) have given HIV patients a longer life expectancy, according to background information in the article. However, strict adherence to the therapy is required to keep HIV viral counts low, and there is a risk of toxic effects and metabolic dysfunction. “Thus, complete control of HIV over time using ART is unlikely, and pharmacotherapeutic limitations leave a significant void in the treatment arsenal,” the authors write. Selenium deficiencies have been observed in patients with HIV spectrum disease and evidence suggests that selenium supplements can improve immune functioning.
Barry E. Hurwitz, Ph.D., University of Miami, and colleagues conducted a double-blind, randomized, placebo-controlled trial of selenium supplements in 262 patients with HIV. Pretreatment assessment included pregnancy screening, blood tests to measure selenium levels, CD4 count (a measure of the state of the immune system; the lower the CD4 count, the more likely a patient with HIV/AIDS is to develop secondary infections or illnesses), HIV viral load (the number of copies of the HIV virus in the blood) and screening for hepatitis C. Participants were then randomly assigned to treatment groups; 141 took a capsule containing 200 micrograms of high-selenium yeast and 121 took a similar capsule containing inactive yeast and a filler material. After nine and 18 months, physical examinations and measures of the study outcomes—HIV viral load and CD4 count—were performed.
Of the 262 patients for whom treatment was initiated, 174 (91 in the selenium group and 83 in the placebo group) completed the nine-month study assessment. “The intervention resulted in no adverse events related to the study supplement,” the authors write. The two groups had similar selenium levels at the beginning of the study, but after nine months of treatment, the average change in blood selenium level was greater in the treatment group. Higher blood selenium levels predicted a decreased HIV viral load, which in turn predicted increased CD4 count.
“The exact mechanism by which selenium exerts its effects on HIV-1 viral replication is not known, although the literature suggests several possibilities,” the authors write. One hypothesis holds that selenium’s antioxidant properties may repair damage done to immune cells by oxygen, which is produced at higher levels in the bodies of patients with HIV. However, future research is needed to confirm this relationship.
“Given the challenges of using conventional pharmacotherapy to achieve and maintain virologic suppression in HIV-spectrum disease, our results support the use of selenium as a simple, inexpensive and safe adjunct therapy,” the authors conclude.
(Arch Intern Med. 2007;167:148-154. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a research grant from the National Institute on Drug Abuse, a grant from the National Institutes of Health, and training grants from the National Heart, Lung and Blood Institute and the National Institute of Mental Health. Nutrition 21 contributed selenium and placebo material and prepared the supplement capsules. 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 22, 2007
Media Advisory: To contact Y. Richard Wang, M.D., Ph.D., call Vivica Aycox at 215-707-7790.
HYPERTENSION CONTROL APPEARS BETTER IN U.S. THAN IN WESTERN EUROPE
CHICAGO—Individuals with diagnosed hypertension in the United States appear to have lower blood pressure readings and better hypertension control than patients in five Western European countries, according to a report in the January 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Hypertension (high blood pressure) affects many individuals and is a strong risk factor for cardiovascular disease, according to background information in the article. Studies suggest that hypertension is widely under-diagnosed and under-treated in the United States and Europe. Guidelines regarding the blood pressure at which treatment should begin differ in various countries, but tend to be more aggressive in the United States.
Y. Richard Wang, M.D., Ph.D., of Temple University Hospital and University of Pennsylvania, Philadelphia, and colleagues analyzed data from a survey of patients with hypertension visiting 291 cardiologists and 1,284 primary care physicians in the United States and five Western European countries: France, Germany, Italy, Spain and the United Kingdom. In 2004, the physicians in the survey were randomly selected, and those who agreed to participate completed two-page diaries for 15 cardiovascular patients. Information collected included patient characteristics, initial blood pressure level before treatment, any co-occurring diseases and the use of seven types of antihypertensive drugs.
Among the total of 21,053 patients from all six countries, 53 percent were male, 23 percent had diabetes and the average age was 65 years. At least 92 percent of patients with hypertension in each country were receiving medication for high blood pressure. The initial blood pressure level before treatment was available for 61 percent to 80 percent of patients per country and was lowest in the United States (average of 161/94 millimeters of mercury, vs. an average of 167 to 173/96 to 99 in Europe). The most recent blood pressure reading was also lower in the United States than in any other country (average of 134/79 millimeters of mercury, vs. an average of 139 to 144/80 to 84 millimeters of mercury in Europe). Only 65 percent of U.S. patients had an initial pre-treatment blood pressure level of 160/100 millimeters of mercury or higher, compared with 81 to 90 percent of European patients.
“The rate of hypertension control (latest blood pressure level, 140/90 millimeters of mercury or lower) was highest in the United States (63 percent vs. 31 percent to 46 percent of patients across European countries),” the authors write. “In addition, of the 11,969 patients with inadequately controlled hypertension, the United States had the highest percentage of patients receiving any medication increase during the visit (38 percent vs. 15 percent to 28 percent across European countries).” The use of medications known as thiazides was similar across countries (29 percent to 31 percent), but the use of other drug classes varied by country, and the use of combination drug therapy was highest in the United States (64 percent vs. 44 percent to 59 percent in Europe).
“Together, our findings suggest that better hypertension control in the United States may be explained by lower treatment thresholds and more intensive treatment, both of which are consistent with the more aggressive treatment guidelines in the United States compared with the other countries examined,” the authors conclude.
(Arch Intern Med. 2007;167:141-147. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the MacLean Center for Clinical Medical Ethics, a grant from the National Institute of Aging and a grant from the Agency for Healthcare Research and Quality. 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 22, 2007
Media Advisory: To contact Nalini Ranjit, Ph.D., call Nancy Ross-Flanigan at 734-647-1853.
PSYCHOSOCIAL FACTORS ASSOCIATED WITH HIGHER LEVELS OF INFLAMMATORY MARKERS
CHICAGO—Psychosocial factors, such as cynical distrust, chronic stress and depression, may be associated with higher levels of inflammatory markers measured in the blood, which in turn are related to an increased risk for cardiovascular disease, according to a report in the January 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
A number of studies have linked psychosocial characteristics with cardiovascular disease and death, according to background information in the article. However, the mechanisms by which they are related are unclear. “Research has highlighted the importance of inflammation in the initiation and development of atherosclerosis and in the precipitation of cardiovascular events,” the authors write. “Inflammation may be a mechanistic pathway linking psychosocial factors to cardiovascular disease.”
Nalini Ranjit, Ph.D., of the University of Michigan, Ann Arbor, and colleagues used data from the Multi-Ethnic Study of Atherosclerosis, a study of 6,814 men and women who were between the ages of 45 to 84 years (average age 62.2) when they enrolled, between 2000 and 2002. Participants filled out a questionnaire with demographic information, and several separate questionnaires that assessed the psychosocial risk factors of depression and chronic stress. Cynical distrust was measured at a follow-up visit between 2002 and 2004. Blood samples obtained at the initial examination were analyzed for IL-6, C-reactive protein and fibrinogen, all markers for inflammation.
The researchers found graded associations between all three psychosocial factors and inflammatory markers. “The strongest and most consistent associations were observed for cynical distrust, which was positively associated with all three inflammatory markers,” the authors write. “Chronic stress was positively associated with the IL-6 level and had a moderately positive association with the CRP level, whereas depression was associated only with the IL-6 level.”
“Associations of psychosocial factors with inflammatory markers were reduced by 20 percent to 55 percent after adjustment for behavioral factors and by 45 percent to 100 percent after adjustment for body mass index (BMI) and diabetes, mostly owing to the effect of BMI,” they continue. “No associations remained after controlling for socioeconomic position, behaviors, BMI and diabetes.”
According to the authors, this suggests that at least part of the link may be due to the mediating role of behaviors—for instance, psychosocial factors may increase the chance that an individual takes up behaviors such as smoking, which results in higher levels of inflammatory markers. Stress and psychosocial factors may contribute to obesity and related metabolic problems, thus explaining the weakening of the association after controlling for BMI and diabetes. In addition, “socioeconomic position is likely to be an antecedent to psychosocial characteristics, as well as to other factors (e.g. behaviors, BMI and diabetes) associated with inflammation,” the authors write. However, further studies are needed to determine the nature of the relationship between inflammation and these mediating factors.
(Arch Intern Med. 2007;167:174-181. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Heart, Lung and Blood Institute and the National Institute of Child Health and Human Development. 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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