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, April 9, 2007)
COCOA, BUT NOT TEA, MAY LOWER BLOOD PRESSURE
PHYSICIANS’ BELIEFS MAY INFLUENCE THEIR PERCEPTION OF THE EFFECTS OF RELIGION AND SPIRITUALITY ON HEALTH
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 9, 2007)
SMOKING AND CAFFEINE INVERSELY ASSOCIATED WITH PARKINSON’S DISEASE
DIABETES MAY BE ASSOCIATED WITH INCREASED RISK OF MILD COGNITIVE IMPAIRMENT
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, April 9, 2007)
ONE DONOR CORNEA MAY TREAT THREE PATIENTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 9, 2007
Media Advisory: To contact Dirk Taubert, M.D., Ph.D., e-mail: dirk.taubert{at}medizin.uni-koeln.de.
COCOA, BUT NOT TEA, MAY LOWER BLOOD PRESSURE
CHICAGO—Foods rich in cocoa appear to reduce blood pressure but drinking tea may not, according to an analysis of previously published research in the April 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Current guidelines advise individuals with hypertension (high blood pressure) to eat more fruits and vegetables, according to background information in the article. Compounds known as polyphenols or flavonoids in fruits and vegetables are thought to contribute to their beneficial effects on blood pressure and cardiovascular risk. “Tea and cocoa products account for the major proportion of total polyphenol intake in Western countries,” the authors write. “However, cocoa and tea are currently not implemented in cardioprotective or anti-hypertensive dietary advice, although both have been associated with lower incidences of cardiovascular events.”
Dirk Taubert, M.D., Ph.D., and colleagues at the University Hospital of Cologne, Germany, conducted a meta-analysis of 10 previously published trials, five of cocoa’s effects on blood pressure and five involving tea. All results were published between 1966 and 2006, involved at least 10 adults and lasted a minimum of seven days. The studies were either randomized trials, in which some participants were randomly assigned to cocoa or tea groups and some to control groups, or used a crossover design, in which participants’ blood pressure was assessed before and after consuming cocoa products or tea.
The five cocoa studies involved 173 participants, including 87 assigned to consume cocoa and 86 controls, 34 percent of whom had hypertension (high blood pressure). They were followed for a median (middle) duration of two weeks. Four of the five trials reported a reduction in both systolic (the top number, when the heart contracts) and diastolic (the bottom number, when the heart relaxes) blood pressure. Compared with those who were not consuming cocoa, systolic blood pressure was an average of 4.7 millimeters of mercury lower and diastolic blood pressure was an average of 2.8 millimeters of mercury lower.
The effects are comparable to those achieved with blood pressure–lowering medications, the authors note. “At the population level, a reduction of 4 to 5 millimeters of mercury in systolic blood pressure and 2 to 3 millimeters of mercury in diastolic blood pressure would be expected to substantially reduce the risk of stroke (by about 20 percent), coronary heart disease (by 10 percent) and all-cause mortality (by 8 percent),” they write.
Of the 343 individuals in the five tea studies, 171 drank tea and 172 served as controls, for a median duration of four weeks. Drinking tea was not associated with a reduction in blood pressure in any of the trials.
Tea and cocoa are both rich in polyphenols, but while black and green tea contain more compounds known as flavan-3-ols, cocoa contains more of another type of polyphenol, procyanids. “This suggests that the different plant phenols must be differentiated with respect to their blood pressure–lowering potential and thus cardiovascular disease prevention, supposing that the tea phenols are less active than cocoa phenols,” the authors write.
The findings do not indicate a widespread recommendation for higher cocoa intake to decrease blood pressure, but it appears reasonable to substitute phenol-rich cocoa products such as dark chocolate for other high-calorie or high-fat desserts or dairy products, they continue. “We believe that any dietary advice must account for the high sugar, fat and calorie intake with most cocoa products,” the authors conclude. “Rationally applied, cocoa products might be considered part of dietary approaches to lower hypertension risk.”
(Arch Intern Med. 2007;167:626-634. 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, April 9, 2007
Media Advisory: To contact Farr A. Curlin, M.D., call John Easton at 773-702-6241.
PHYSICIANS’ BELIEFS MAY INFLUENCE THEIR PERCEPTION OF THE EFFECTS OF RELIGION AND SPIRITUALITY ON HEALTH
CHICAGO—More than half of physicians believe that religion and spirituality have a significant influence on patients’ health, according to a report in the April 9 issue of Archives of Internal Medicine, one of the Archives of Internal Medicine, one of the JAMA/Archives journals. Physicians who are most religious are more likely to interpret the influence of religion and spirituality in positive ways.
The relationship between religion and health generates controversy in the medical world, according to background information in the article. “Consensus seems to begin and end with the idea that many (if not most) patients draw on prayer and other religious resources to navigate and overcome the spiritual challenges that arise in their experiences of illness,” the authors note. “Controversy remains regarding whether, to what extent and in what ways religion and spirituality helps or harms patients’ health.”
Farr A. Curlin, M.D., and colleagues at the University of Chicago mailed a survey in 2003 to a random sample of 2,000 practicing U.S. physicians 65 years or younger from all specialties. The survey included questions to determine physicians’ religious characteristics, general observations and interpretations of religion and spirituality and potential positive and negative influences of religion and spirituality.
The response rate was 63 percent (1,144 of 1,820) and the average age for respondents was 49. According to the study, two-thirds of U.S. physicians believe that experiencing illness often or always increases patients’ awareness of religion and spirituality issues. A majority of physicians (56 percent) think that religion and spirituality has much or very much influence on health and 54 percent believe that at times a supernatural being intervenes. The majority of physicians (85 percent) believe that the influence of religion and spirituality is generally positive, but few (6 percent) feel that religion and spirituality changes medical outcomes.
The study also found that 76 percent of physicians believe that religion and spirituality helps patients cope, 74 percent believe that it gives patients a positive state of mind and 55 percent report that it provides emotional and practical support through religious community. Few physicians (7 percent) believe that religion and spirituality often causes negative emotions such as guilt and anxiety, 2 percent think it leads patients to decline medical therapy and 4 percent report that patients use it to avoid taking responsibility for their health, but about one-third believe it has these harmful influences sometimes.
Physicians’ observations and interpretations are strongly influenced by their religious beliefs, according to the authors. “Physicians with higher intrinsic religiosity are much more likely to (1) report that their patients bring up religion and spirituality issues, (2) believe that religion and spirituality strongly influences health and (3) interpret the influence of religion and spirituality in positive rather than negative ways.”
These findings lend support to recommendations that physicians recognize how their own beliefs influence how they provide care, the authors note. “Physicians’ notions about the relationship between religion and spirituality and patients’ health are strongly associated with physicians’ own religious characteristics,” they conclude. “Future studies should examine the ways physicians’ religious (and secular) commitments shape their clinical engagements in these and other domains.”
(Arch Intern Med. 2007;167:649-654. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by a grant from the Greenwall Foundation and by the Robert Wood Johnson Clinical Scholars Program. Dr. Curlin is also supported by a grant from the National Center for Complementary and Alternative Medicine of the 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 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, April 9, 2007
Media Advisory: To contact corresponding author William K. Scott, Ph.D., call Omar Montejo at 305-243-5654.
SMOKING AND CAFFEINE INVERSELY ASSOCIATED WITH PARKINSON’S DISEASE
CHICAGO—Individuals with Parkinson’s disease are less likely to smoke or consume high doses of caffeine than their family members who do not have the disease, according to a report in the April issue of Archives of Neurology, one of the JAMA/Archives journals.
Smoking cigarettes, consuming caffeine and taking non-steroidal anti-inflammatory (NSAID) medications (such as aspirin, ibuprofen and naproxen) have been reported to protect individuals from developing Parkinson’s disease, according to background information in the article. However, little family-based research has examined these associations. Studying individuals with Parkinson’s disease and their families enables scientists to limit the number of unknown genetic and environmental factors influencing the development of the condition.
Dana B. Hancock, B.S., of Duke University Medical Center, Durham, N.C., and colleagues assessed the associations between smoking, caffeine and NSAID use and Parkinson’s disease in 356 Parkinson’s disease patients (average age 66.1) and 317 family members without the disease (average age 63.7). Participants were evaluated clinically to confirm their Parkinson’s disease status and then interviewed by phone to determine their exposure to environmental factors.
“Individuals with Parkinson’s disease were .56 times as likely to report ever smoking and .30 times as likely to report current smoking compared with unaffected relatives,” the authors write. “Increasing intensity of coffee drinking was inversely associated with Parkinson’s disease. Increasing dosage and intensity of total caffeine consumption were also inversely associated, with high dosage presenting a significant inverse association with Parkinson’s disease.” There was no link between NSAID use and Parkinson’s disease.
The biological mechanisms through which smoking and caffeine might work in individuals at risk of Parkinson’s disease is unknown, the authors note. “Given the complexity of Parkinson’s disease, these environmental factors likely do not exert their effects in isolation, thus highlighting the importance of gene-environment interactions in determining Parkinson’s disease susceptibility,” they conclude. “Smoking and caffeine possibly modify genetic effects in families with Parkinson’s disease and should be considered as effect modifiers in candidate gene studies for Parkinson’s disease.”
(Arch Neurol. 2007;64:576-580. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was supported by grants from the National Institute of Neurological Disorders and Stroke, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 9, 2007
Media Advisory: To contact co-author Richard Mayeux, M.D., call Craig LeMoult at 212-305-0820.
DIABETES MAY BE ASSOCIATED WITH INCREASED RISK OF MILD COGNITIVE IMPAIRMENT
CHICAGO—Individuals with diabetes may have a higher risk of developing mild cognitive impairment, a condition that involves difficulties with thinking and learning and may be an intermediate step toward Alzheimer’s disease, according to a report in the April issue of Archives of Neurology, one of the JAMA/Archives journals.
“Among cardiovascular risk factors, type 2 diabetes mellitus has been consistently related to a higher risk of Alzheimer’s disease,” the authors write as background information in the article. Mild cognitive impairment—particularly a type known as amnestic mild cognitive impairment, which affects memory more significantly than non-amnestic mild cognitive impairment—is increasingly recognized as a transitional state between normal functioning and Alzheimer’s disease.
José A. Luchsinger, M.D., and colleagues at Columbia University Medical Center, New York, studied 918 individuals older than 65 years (average age 75.9) who did not have mild cognitive disorder or dementia when they enrolled between 1992 and 1994. At the beginning of the study and again every 18 months through 2003, each participant underwent an in-person interview and standard assessment, which included a medical history, physical and neurological examination, and a battery of neurological tests that measured learning, memory, reason and language skills, among others. Of the participants, 23.9 percent had diabetes, 68.2 percent had hypertension, 33.9 percent had heart disease and 15 percent had had a stroke.
During an average of 6.1 years of follow-up, 334 individuals developed mild cognitive impairment, including 160 amnestic cases and 174 non-amnestic cases. Diabetes was related to a significantly higher risk of mild cognitive impairment overall and of amnestic mild cognitive impairment specifically after controlling for other factors that may affect risk, including age, ethnic group, years of education and heart and blood vessel disease. “The risk of mild cognitive impairment attributable to diabetes was 8.8 percent for the whole sample, 8.4 percent for African-American persons, 11 percent for Hispanic persons and 4.6 percent for non-Hispanic white persons, reflecting the differences in diabetes prevalence by ethnic group,” the authors write.
Diabetes could be related to a higher risk for amnestic mild cognitive impairment by directly affecting the build-up of plaques in the brain, a hallmark characteristic of Alzheimer’s disease, the authors note. In addition, cerebrovascular disease—diseases such as stroke that affect the vessels supplying blood to the brain—is related to both diabetes and Alzheimer’s disease.
“Our results provide further support to the potentially important independent role of diabetes in the pathogenesis of Alzheimer’s disease,” the authors conclude. “Diabetes may also be a risk factor for non-amnestic forms of mild cognitive impairment and cognitive impairment, but our analyses need to be repeated in a larger sample.”
(Arch Neurol. 2007;64:570-575. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Support for this work was provided by National Institutes of Health grants, the Charles S. Robertson Memorial Gift for Research on Alzheimer’s Disease, the Blanchette Hooker Rockefeller Foundation and the New York City Council Speaker’s Fund for Public Health Research. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, April 9, 2007
Media Advisory: To contact Rasik B. Vaypayee, M.S., F.R.C.S., F.R.A.N.Z.C.O., e-mail: rvajpayee{at}gmail.com.
ONE DONOR CORNEA MAY TREAT THREE PATIENTS
CHICAGO—One donor cornea may be divided and transplanted into multiple patients with eye disease or damage, according to a report in the April issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Transplantation of the cornea, the clear membrane that covers the front of the eye, was first performed in 1905, according to background information in the article. Recent developments have allowed ophthalmologic surgeons to move from transplanting the entire cornea in every patient to more focused operations that involve removing and replacing only the diseased or damaged portion of the cornea. “Such surgical techniques provide an opportunity to make use of a single donor cornea in more than one patient,” the authors write.
Rasik B. Vajpayee, M.S., F.R.C.S., F.R.A.N.Z.C.O., then of the All India Institute of Medical Sciences, New Delhi, and now of the University of Melbourne, East Melbourne, Australia, and colleagues used one cornea from a 44-year-old donor who had died of cardiac arrest to complete transplants in three patients. The corneal tissue was divided into three parts.
The first patient, a 40-year-old man, had a degenerative cornea disease that appeared only to affect the front two-thirds of his corneal tissue. He received the front portion of the donor cornea through a procedure known as automated lamellar therapeutic keratoplasty (ALTK), in which a thin slice of tissue is removed. His visual acuity before surgery was 20/200.
The second patient, a 60-year-old man, developed complications following cataract surgery and had a visual acuity of 20/400. He received the rear portion of the cornea through a technique known as Descemet stripping automated endothelial keratoplasty (DSAEK), which involves replacing damaged endothelium, or the layer of cells on the inside of the cornea.
The third patient was a 5-year-old boy who had chemical burns in his right eye. Stem cells from the donor cornea, at the junction of the cornea and conjunctiva (the membrane that covers the outer eye and inner eyelid), were transplanted to improve his vision, which was limited to counting fingers close to his face.
The procedures were all performed on the same day and were all successful. New tissue grew over the transplant in the ALTK patient after four days, and after three months the patient’s visual acuity improved to 20/60. In the DSAEK patient, minor swelling in the graft cleared within two weeks, and visual acuity improved to 20/40 after three months. New tissue grew in the child after one week, and at the three-month follow-up visit, his vision had improved to 20/200.
“Our strategy of using a single donor corneal tissue for multiple patients opens up the possibility of optimal use of available donor corneal tissue and will reduce the backlog of patients with corneal blindness in countries in which there is a dearth of good-quality donor corneal tissue,” the authors write. This includes India, where 300,000 donor corneas are needed each year but only 15,000 are available, with almost half of those unsuitable for transplantation. “With more corneal surgeons converting to techniques of customized component corneal transplantation in the form of anterior and posterior lamellar disc corneal transplantation, the use of a single donor cornea in more than one patient may become standard surgical practice.”
(Arch Ophthalmol. 2007;125:552-554. 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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