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, June 25, 2007)
COMMONLY PRESCRIBED ANTIDEPRESSANTS ASSOCIATED WITH LOWER BONE DENSITY IN OLDER MEN AND WOMEN
PORTION-CONTROL DISHES MAY HELP OBESE DIABETICS LOSE WEIGHT
SARS SURVIVORS RECOVER FROM PHYSICAL ILLNESS, BUT MAY EXPERIENCE MENTAL HEALTH DECLINE
PERSONAL DISCLOSURES BY PHYSICIANS ARE COMMON, MAY DISRUPT PATIENT CARE
OBESITY ASSOCIATED WITH A LOWER RISK OF TUBERCULOSIS IN OLDER CHINESE POPULATION
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA website 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
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 25, 2007
Media Advisory: To contact Susan J. Diem, M.D., M.P.H., call Sara Buss at 612-624-2449. To contact Elizabeth M. Haney, M.D., call Jonathan Modie at 503-494-8231. To contact Kenneth Saag, M.D., M.Sc., call Troy Goodman at 205-789-6504.
COMMONLY PRESCRIBED ANTIDEPRESSANTS ASSOCIATED WITH LOWER BONE DENSITY IN OLDER MEN AND WOMEN
CHICAGO—The class of antidepressant medications known as selective serotonin reuptake inhibitors may be associated with an increased rate of bone loss in older men and women, according to two articles in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Selective serotonin reuptake inhibitors (SSRIs) treat depression by inhibiting the protein that transports serotonin, a neurotransmitter involved in sleep and depression, according to background information in the articles. This protein has recently been discovered in bone as well, raising the possibility that SSRIs may affect bone density and the risk of fracture. SSRIs account for about 62 percent of antidepressant prescriptions in the United States, and are often prescribed to the elderly.
Susan J. Diem, M.D., M.P.H., University of Minnesota, Minneapolis, and colleagues studied 2,722 older women (average age 78.5 years) beginning in 1997 through 1999. At that time and again an average of 4.9 years later, researchers measured women’s total hip bone density and also that of two subregions. At each visit, the participants were asked to bring in all the medications they had used within the past two weeks, including SSRIs and tricyclic antidepressants, which work through a different mechanism.
A total of 198 (7.3 percent) of the women were SSRI users, 118 (4.3 percent) took tricyclic antidepressants and 2,406 (88.4 percent) took neither (those who took both were not included in the analysis). After the researchers adjusted for other factors affecting bone density and antidepressant use, including depression severity and calcium supplement use, bone mineral density at the hip decreased 0.82 percent in SSRI users. This compared with a decrease of 0.47 percent among those who used tricyclic antidepressants and also in those who did not take any antidepressants. Higher rates of bone loss were also observed at the two hip subregions among SSRI users.
“One potential explanation for our findings is that SSRI use may have a direct deleterious effect on bone,” the authors write. “This theory is supported by findings of in vitro and in vivo laboratory investigations.” Some data suggest that SSRIs may interfere with the function of osteoclasts and osteoblasts, cells responsible for the regular breaking down and rebuilding of bone in the body.
“Our findings suggest that, in this cohort, use of SSRIs is associated with increased rates of hip bone loss,” the authors conclude. Although some of this association may have occurred because women who were prescribed SSRIs were different from those who were not prescribed SSRIs, “further investigation of SSRI use and rates of change in bone mineral density in other populations with longer follow-up is warranted given the recent description of serotonin transporters in bone.”
In a related paper, Elizabeth M. Haney, M.D., of Oregon Health & Sciences University, Portland, and colleagues conducted a similar study with 5,995 men age 65 and older (average age 73.7). The men’s bone density at the hip, including subregions, and at the base of the spine were measured between 2000 and 2002. Participants were asked to bring all medications to their clinic visit, where they were also given a physical examination and asked about other health and lifestyle factors.
A total of 160 (2.7 percent) men reported using SSRIs, 99 (1.7 percent) reported using tricyclic antidepressants and 52 (0.9 percent) reported using trazodone, a third type of antidepressant. Total hip bone mineral density was 3.9 percent lower among SSRI users than among men who didn’t use any antidepressants. Similarly, spine bone mineral density was 5.9 percent lower among SSRI users than among non-users. There was no significant difference in either hip or spine density between men who took tricyclic antidepressants or trazodone and those who did not take antidepressants.
“These associations are biologically plausible and clinically important,” the authors conclude. “Because SSRI use is prevalent in the general population, our findings have a potentially important public health impact. If confirmed, people using SSRIs might be targeted for osteoporosis screening and preventive intervention.”
(Arch Intern Med. 2007;167:1240-1245 and 1246-1251. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PHYSICIANS MUST BALANCE BETWEEN TREATING MINDS, SPARING BONES
Although these studies do not prove definitively that SSRIs cause a reduction in bone mineral density, they do raise concerns that physicians must consider when they write prescriptions for antidepressant medications, writes Kenneth Saag, M.D., M.Sc., of the University of Alabama at Birmingham in an accompanying editorial.
“The SSRI risk-benefit ratio should be compared against traditional antidepressants as well as alternative approaches such as newer drugs, psychotherapy and even electroconvulsive therapy,” Dr. Saag writes.
For many patients, the benefits of SSRIs are likely to out weight the risks, Dr. Saag continues. “Although it is not appealing to use a second medicine to ‘chase’ the adverse effects of a first one, if needed, there are many good options that exist to prevent bone loss.”
As medicine advances, it is not surprising that physicians are finding new ways to improve one health problem while worsening another, he concludes. “The astute clinician individually tailors therapies, tries to balance benefits against potential risks and provides appropriate and informed consent for all drugs prescribed. In the case of the depressed patient, good clinical acumen and thoughtful adverse event monitoring can help avoid having healthier minds at the expense of sicker bones.”
(Arch Intern Med. 2007;167:1231-1232. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Dr. Saag has served as a consultant to, or speaker for, or has received grant funding in the area of osteoporosis from Merck & Co, Aventis, Eli Lilly and Co, Novartis, Roche, Arngen and GlaxoSmithKline. He is partially supported by a grant from the Agency for Healthcare Research and Quality and a grant from the National Institutes of Health. Please see the article for additional information, including 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 25, 2007
Media Advisory: To contact Sue D. Pedersen, M.D., F.R.C.P.C., call Rhonda Watson at 403-210-3835.
PORTION-CONTROL DISHES MAY HELP OBESE DIABETICS LOSE WEIGHT
CHICAGO—A plate and cereal bowl with markers for proper portion sizes appear to help obese patients with diabetes lose weight and decrease their use of glucose-controlling medications, according to a report in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Between 1960 and 2000, the proportion of U.S. adults who were obese increased from 13.4 percent to 30.9 percent, according to background information in the article. Most cases of type 2 diabetes can be attributed directly to obesity. Restricting calories has been shown to improve blood sugar control in diabetics, partially by contributing to weight loss. “The increasing prevalence of obesity is paralleled by increasing portion sizes in the marketplace,” the authors write. “Portion sizes are an important determinant of energy intake; the number of calories ingested by subjects at a meal has been directly correlated with the serving size offered.”
Sue D. Pedersen, M.D., F.R.C.P.C., and colleagues at the University of Calgary, Alberta, Canada, conducted a six-month controlled trial of commercially available portion control plates and bowls in 2004. The plates were divided into sections for carbohydrates, proteins, cheese and sauce, with the rest left open for vegetables. The sections approximately totaled an 800-calorie meal for men and a 650-calorie meal for women. The cereal bowl is designed to allow a 200-calorie meal of cereal and milk. Half of 130 obese patients with diabetes (average age 56) were randomly assigned to use the plate for their largest meal and the bowl when they ate cereal for breakfast. The other half of the participants received usual care, which consisted of dietary assessment and teaching by dieticians.
At the end of the six-month follow-up, 122 patients remained in the study. Individuals using the portion-control dishes lost an average of 1.8 percent of their body weight, while those receiving usual care lost an average of 0.1 percent. A significantly larger proportion of those using the dishes—16.9 percent vs. 4.6 percent—lost at least 5 percent of their body weight. “This is important, as a 5 percent weight loss has been shown to be clinically significant in terms of decreasing morbidity and mortality associated with obesity-linked disorders such as cancer and myocardial infarction [heart attack],” the authors write.
In addition, more of those in the intervention group vs. the regular care group experienced a decrease in their use of diabetes medications after six months (26.2 percent vs. 10.8 percent).
“In conclusion, the portion control tool studied in this trial was effective in inducing weight loss in obese persons with type 2 diabetes mellitus comparable to that seen in investigations of weight loss pharmacotherapy,” the authors write. “This simple, inexpensive tool also enabled obese patients with diabetes mellitus to decrease their hypoglycemic medication requirements. This intervention holds promise for use in overweight populations with and without diabetes mellitus.”
(Arch Intern Med. 2007;167:1277-1283. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was sponsored by the Stewart Diabetes Education Fund. Portion control tools were donated for use in the study by The Diet Plate. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 25, 2007
Media Advisory: To contact corresponding author Margaret S. Herridge, M.D., M.P.H., call Eva Lannon at 416-340-4011
SARS SURVIVORS RECOVER FROM PHYSICAL ILLNESS, BUT MAY EXPERIENCE MENTAL HEALTH DECLINE
CHICAGO—Most patients who survived severe acute respiratory syndrome (SARS) had good physical recovery, but they or their caregivers often reported a decline in mental health one year later, according to a study in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“Severe Acute Respiratory syndrome (SARS) became a global epidemic in 2003. Most cases were in Asia, and the largest concentration of North American cases occurred in Toronto, Ontario,” according to background information in the article. “The longer-term physical and psychological consequences of SARS were not reported until recently.” Investigations of the disease have focused on lung function, distance walked in six minutes and health-related quality of life.
Catherine M. Tansey, M.Sc., University Health Network, Toronto, and colleagues, evaluated 117 SARS survivors from Toronto who were discharged from the hospital in 2003. Patients were evaluated three, six and 12 months after leaving the hospital by undergoing a physical examination, a six-minute walk test, a lung function test, a chest X-ray and quality-of-life measures and reporting how often they saw a physician. Formal caregivers of survivors were given a survey on caregiver burden one year after patient discharge.
All but one patient had chest X-rays demonstrating normal or pre-SARS condition by one year. At three months, 31 percent of the survivors had a reduced six-minute walk distance and at one year, 18 percent did. For most, lung capacity measures and the lung’s ability to exchange respiratory gases were within normal limits at three months and during the rest of the follow-up period.
General health, vitality and social functioning remained below the normal range one year after discharge from the hospital. Many patients returned to work part-time, increasing their workload over the first two months while 23 patients returned to work full-time with no need for a modified schedule. “At one year, 17 percent of patients had not returned to work, and a further 9 percent had not returned to their pre-SARS level of work,” the authors note.
Survivors used health care services frequently the first year after hospitalization. “Psychiatric evaluation accounted for the greatest number of visits,” the authors write. “Of the patients, 74 percent saw their primary care physician a median of five times. Infectious disease specialists assessed 72 percent of patients, mostly in the first three months after discharge.” Caregiver surveys showed a decline in the mental health of caregivers, which was caused by reported lifestyle interference and loss of control.
“We have shown that most SARS survivors have pulmonary and functional recovery from their acute illness. However, one year after discharge from hospital, health-related quality of life remained lower than in the general population, and patients reported important decrements in mental health. These findings are reflected in the notable utilization of psychiatric and psychological services in the one-year follow-up period,” the authors conclude. “These data may help to highlight the needs of patients and caregivers during and after an epidemic, the potential benefit of a family-centered approach to follow-up care, and the importance of exploring strategies to minimize the psychological burden of an epidemic illness as part of future pandemic planning initiatives.”
(Arch Intern Med. 2007;167:1312-1320. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Ontario Thoracic Society (OTS) and Canadian Institutes of Health Research (CIHR). 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 25, 2007
Media Advisory: To contact Susan H. McDaniel, Ph.D., call Michael Wentzel at 585-275-1309.
PERSONAL DISCLOSURES BY PHYSICIANS ARE COMMON, MAY DISRUPT PATIENT CARE
CHICAGO—In a study involving unannounced visits by actors portraying new patients, primary care physicians shared personal information about one-third of the time, according to a report in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Only 10 (14 percent) of these disclosures were in response to a patient question, and most (62, or 85 percent) appeared not to be useful to the patient.
Communication between physicians and patients appears to improve patients’ health, but little is known about how best to create healing relationships, according to background information in the article. “In particular, physician self-disclosure, when the physician shares personal information and/or experiences, has generated controversy,” the authors write. “Despite seeming to be a way to strengthen the patient-physician relationship, recent evidence has called this into question.”
Susan H. McDaniel, Ph.D., of the University Rochester School of Medicine and Dentistry, N.Y., and colleagues recruited 100 primary care physicians, who agreed to have actors portraying new patients visit their offices unannounced in 2000 or 2001. The researchers then analyzed transcripts of 113 visits between the physicians and the actors, who were trained to represent standardized patients with common complaints (gastrointestinal reflux disease or unexplained symptoms). Visits in which the physician suspected the patient were actors were not included in the results. Self-disclosures were defined as instances where physicians made statements about personal or professional experiences, including family members, health problems, interactions with other health care professionals or political beliefs.
In 38 (34 percent) of 113 visits, 73 separate physician self-disclosures were identified. These occurred throughout the visit but most often (38 percent) during the time when the physician was taking a medical history or gathering information about the patient before the physical examination. “Forty-four (60 percent) followed patient symptoms, family or feelings; 29 (40 percent) were unrelated,” the authors write. “Only 29 encounters (21 percent) returned to the patient topic preceding the disclosure.”
“Only three physician self-disclosures (4 percent) were coded as useful—providing education, support, explanation or acknowledgement, or prompting some indication from the patient that it had been helpful,” they continue. In all three of those cases, the physician disclosed that he or she had the same medical condition as the patient. Eight (11 percent) of the disclosures were considered disruptive, or detracting in some way from the physician-patient relationship. These included instances where the physician talked about himself or herself for an extended period of time, inadvertently competed with the patient, requested the patient’s support or expressed personal or political viewpoints that did not take the patient’s perspective into account.
“We found that physician self-disclosures were often non sequiturs, unattached to any discussion in the visit, and focused more on the physician’s than the patient’s needs. Longer disclosures, both not useful and disruptive, interrupted the flow of information exchange and expended valuable patient time in the typically time-pressured primary care visit,” the authors conclude. “Our analysis suggests that physician self-disclosure usually is of little value and, occasionally, can actually impair the physician-patient relationship. Primary care physicians may wish to make explicit decisions about any use of self-disclosure and consider using empathy and other ways of demonstrating support and building relationships.”
(Arch Intern Med. 2007;167:1321-1326. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by a grant from the University of Rochester Family Research Roundtable Small Grants Program (Dr. McDaniel) and a grant from the Agency for Healthcare Research and Quality, Rockville, Md. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 25, 2007
Media Advisory: To contact Chi C. Leung, M.B.B.S., e-mail: cc_leung{at}dh.gov.hk.
OBESITY ASSOCIATED WITH A LOWER RISK OF TUBERCULOSIS IN OLDER CHINESE POPULATION
CHICAGO—Obese or overweight Chinese individuals age 65 and older have a lower risk of developing tuberculosis than those at a normal weight, according to a study in the June 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“Tuberculosis is commonly associated with poverty and undernutrition in both developed and developing countries. In addition, obesity is an increasing problem that is associated with a wide range of chronic degenerative conditions, notably, diabetes mellitus, a well-reported predisposing factor for active tuberculosis,” according to background information in the article. “Few studies have systematically examined the effect of obesity and overweight on tuberculosis, especially in Asian populations.”
Chi C. Leung, M.B.B.S., Tuberculosis and Chest Service, Hong Kong, and colleagues, studied 42,116 individuals 65 years or older enrolled in 18 health centers for elderly patients in Hong Kong. The patients were followed up from three months after enrollment in 2000 until December 31, 2005. The body mass index (BMI) of each patient was measured at the beginning of the study. Those with a BMI of less than 18.5 were grouped as underweight, 18.5 to less than 23 as normal, 23 to less than 25 as at risk (for obesity), 25 to less than 30 as overweight, and 30 or higher as obese.
During the follow-up period, 477 cases of active tuberculosis were reported, 326 (68.3 percent) of which were confirmed using cultures of the bacteria involved. The average time between enrollment and notification of tuberculosis was 881 days. “There were 395 new cases (82.8 percent) and 82 retreatment cases (17.2 percent). Pulmonary [lung] involvement was found in 426 cases (89.3 percent) and extrapulmonary [outside the lung] involvement in 87 (18.2 percent), including 36 cases (7.5 percent) with both,” the authors write.
Individuals who developed active tuberculosis were taller on average, but had a lower body weight and BMI (22.5 vs. 24.3) at the beginning of the study than those who did not. “BMI outside the range of 18.5 to 23 decreased the active tuberculosis risk by 23.5 percent of the observed level. Baseline BMI obesity at 25 or above was associated with a 30.1 percent decrease in risk, whereas BMI lower than 18.5 increased the risk by 6.6 percent,” according to the authors. A higher average initial BMI was found in pulmonary-only cases than in extrapulmonary-only cases (22.3 vs. 24.1).
“Obesity is associated with a lower risk of active pulmonary tuberculosis in the older population of Hong Kong,” the authors conclude. “The presence of such a strong but selective association across the whole spectrum of BMI could have major biological, clinical and/or epidemiological implications. Further studies are indicated to explore the underlying mechanisms, potential clinical utilities and possible epidemiological consequences.”
(Arch Intern Med. 2007;167:1297-1304. 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.
Go back to the top.
