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, August 6, 2007)
MATERNAL OBESITY PRIOR TO PREGNANCY ASSOCIATED WITH BIRTH DEFECTS
YOUNG CHILDREN’S TASTE PREFERENCES MAY BE INFLUENCED BY FAST-FOOD BRANDING
EARLY-CHILDHOOD INTERVENTION MAY IMPROVE WELL-BEING THROUGH YOUNG ADULTHOOD
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, August 6, 2007)
ADHD APPEARS TO BE ASSOCIATED WITH DEPRESSED DOPAMINE ACTIVITY IN THE BRAIN
GENE VARIANT IS ASSOCIATED WITH BRAIN ANATOMY, CLINICAL COURSE OF ADHD
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 6, 2007
Media Advisory: To contact D. Kim Waller, Ph.D., call David Bates at 713-500-3030.
MATERNAL OBESITY PRIOR TO PREGNANCY ASSOCIATED WITH BIRTH DEFECTS
CHICAGO—Mothers of babies born with some structural birth defects—including missing limbs, malformed hearts and underdeveloped spinal cords—appear more likely to be obese prior to becoming pregnant than mothers whose children are born without such defects, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Overweight and obese women are known to be at risk for chronic diseases, infertility, irregular menstruation and complications during pregnancy, according to background information in the article. In 2003 and 2004, about 51 percent of women aged 20 to 39 were classified as overweight or obese.
D. Kim Waller, Ph.D., of the University of Texas, Houston, and colleagues interviewed 10,249 women in eight states whose babies were born with birth defects between 1997 and 2002. The women were contacted between six weeks and 24 months after the baby’s birth and asked for their height and weight before pregnancy, along with other demographic and medical information. These women were compared with 4,065 women who had babies without birth defects during the same time period.
Mothers of babies with the following seven of 16 birth defects were more likely to be obese than mothers of infants without birth defects:
- Spina bifida, a condition that occurs when part of the spinal cord is uncovered, causing incontinence and problems with mobility
- Heart defects
- Anorectal atresia, malformation of the anal opening
- Hypospadias, which occurs when the urethra opens on the underside instead of the end of the penis
- Limb reduction defects, such as small or missing toes, fingers, arms or legs
- Diaphragmatic hernia, or an opening in the diaphragm that allows abdominal organs to move into the chest cavity and may cause lungs to be underdeveloped
- Omphalocele, in which the intestines or other abdominal organs protrude out through the navel
Mothers of babies with gastroschisis, which is similar to omphalocele but involves organs protruding through a defect in the abdominal wall that is not the navel, were significantly less likely to be obese than mothers of babies without birth defects.
“The reasons for an association between maternal obesity and a spectrum of structural birth defects are unknown,” the authors write. “Both animal studies and human studies provide substantial evidence that alterations in glycemic control are responsible for an increased risk of a range of structural birth defects among women who have diabetes prior to becoming pregnant. Thus, a similar mechanism to that occurring in women with diabetes may be responsible for the associations observed between maternal obesity and specific categories of birth defects.” Women with type 2 diabetes were excluded from the study, and when the analysis was performed also excluding women with gestational diabetes, the results were similar. However, undiagnosed cases of type 2 or gestational diabetes may have affected the results.
“Our study supports previous evidence as well as provides new evidence for the associations between maternal obesity and particular categories of birth defects,” the authors conclude. “Future inquiries are needed to unravel the underlying reasons for these associations.”
(Arch Pediatr Adolesc Med. 2007;161(8):745-750. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported through a cooperative agreement from the Centers for Disease Control and Prevention to the Texas Department of State Health Services Center for Birth Defects Research and Prevention. Co-authors Drs. Rasmussen and Correa work with the Centers for Disease Control and Prevention. 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, August 6, 2007
Media Advisory: To contact Thomas N. Robinson, M.D., M.P.H., call Krista Conger, Ph.D., at 650-725-5371.
YOUNG CHILDREN’S TASTE PREFERENCES MAY BE INFLUENCED BY FAST-FOOD BRANDING
CHICAGO—Preschool children preferred the taste of foods and drinks in McDonald’s packaging to the same foods and drinks in unbranded packaging, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Food marketing to children is widespread. The food and beverage industries spend more than $10 billion per year to market to children in the United States,” according to background information in the article. By age 2, children may already have beliefs about certain brands and 2- to -6-year-olds can recognize brands and associate them with products.
In a study by Thomas N. Robinson, M.D., M.P.H., Stanford University School of Medicine, California, and colleagues, preschoolers age 3 to 5 tasted five pairs of identical foods and beverages in basic McDonald’s packaging and in matched but unbranded packaging. The foods and beverages were: one-quarter of a McDonald’s hamburger, a Chicken McNugget, McDonald’s french fries, about three ounces of 1 percent fat milk (or apple juice for one child who was not allowed to drink milk) and two baby carrots. Parents completed a questionnaire including their child’s race/ethnicity, age, exposure to McDonald’s food and toys and television viewing habits.
A total of 63 children completed the study and performed a total of 304 individual tasting comparisons. On average, children preferred the tastes of foods and drinks in the McDonald’s packaging over the same foods in unmarked packaging (48.3 percent vs. 36.7 percent for hamburgers, 59 percent vs. 18 percent for chicken nuggets, 76.7 percent vs. 13.3 percent for french fries, 61.3 percent vs. 21 percent for milk or apple juice and 54.1 percent vs. 23 percent for carrots). A secondary analysis found that children preferred the tastes of foods and drinks that were thought to be from McDonald’s for four out of five comparisons. Preschoolers with more television sets in their homes and children who ate McDonald’s food more often were more likely to prefer foods and drinks they thought were from McDonald’s.
“These results add evidence to support recommendations to regulate or ban advertising or marketing of high-calorie, low-nutrient foods and beverages, or all marketing, that is directed to young children,” the authors write. “Our findings also suggest a need for research on marketing in general, and branding in particular, as strategies to promote more healthful taste preferences and food and beverage choices in young children.”
“Future research might examine the effects of less recognizable brands or contrast different brands and packaging with variable levels of recognition and natural exposure,” they conclude.
(Arch Pediatr Adolesc Med. 2007;161(8):792-797. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported in part by a Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award (T.N.R) and support from the Department of Pediatrics and the Stanford Prevention Research Center, Stanford University School of Medicine. 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, August 6, 2007
Media Advisory: To contact Arthur J. Reynolds, Ph.D., call Drew Swain at 612-625-8962. To contact editorialist David Olds, Ph.D., call Tonya Ewers-Maikish at 303-724-1520. To contact editorialist James Forman Jr., J.D., call Elissa Blake Free at 202-662-9500.
EARLY-CHILDHOOD INTERVENTION MAY IMPROVE WELL-BEING THROUGH YOUNG ADULTHOOD
CHICAGO—Minority preschoolers from low-income families who participated in a comprehensive school-based intervention appear to fare better educationally, criminally and economically into young adulthood, according to a report in the August issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Early childhood interventions have demonstrated consistent positive effects on children’s health and well-being,” the authors write as background information in the article. The types of programs that have received the largest growth in public funding are preschool programs for mostly at-risk 3- and 4-year-olds that provide both educational and family services in a center-based environment. One such intervention, the Child-Parent Center program in Chicago, is available from preschool through third grade and features instruction by qualified teachers, low child-to-staff ratios, health and nutrition services and an intensive parent program that includes classroom involvement, field trips and home visits.
Arthur J. Reynolds, Ph.D., of the University of Minnesota, Minneapolis, and colleagues, studied the long-term effects of the Child-Parent Center program. A total of 1,539 low-income minority children who were born in 1979 or 1980 and attended programs at 25 sites between 1985 and 1986 were compared with 550 children who participated in alternative full-day kindergarten programs available to low-income families. The children were tracked through age 24 using various methods, including records from schools, Medicaid and county, state and federal agencies, as well as a survey completed by the participants between ages 22 and 24 years.
By age 24, children who had participated in the Child-Parent Center preschool were:
- More likely to have finished high school (71.4 percent vs. 63.7 percent) and to be attending four-year colleges (14.7 percent vs. 10 percent)
- More likely to have health insurance coverage (70.2 percent vs. 61.5 percent)
- Less likely to be arrested for a felony (16.5 percent vs. 21.1 percent) or incarcerated (20.6 percent vs. 25.6 percent)
- Less likely to have depressive symptoms (12.8 percent vs. 17.4 percent
Children who participated in the program during school years also were more likely to be working full-time (42.7 percent vs. 36.4 percent), have completed more years of education and have lower rates of arrests for violent offenses (13.9 percent vs. 17.9 percent), and were less likely to receive disability assistance (4.4 percent vs. 7 percent).
The fact that positive results of the program extend beyond educational achievements is not surprising given the links between education, mental and physical health and behavior, the authors note. “Because expenditures for the medical care and justice systems comprise roughly 20 percent of the gross domestic product, the potential cost savings to governments and taxpayers of early childhood prevention programs are considerable,” they write.
(Arch Pediatr Adolesc Med. 2007;161(8):730-739. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was supported by grants from the National Institute of Child Health and Human Development and from the Doris Duke Charitable Foundation, as well as by the Foundation for Child Development, the National Institute for Early Education Research, the McCormick Tribune Foundation and the University of Wisconsin, Madison Graduate School. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: CAREFULLY DESIGNED TRIALS NEEDED TO BOLSTER CASE FOR PRESCHOOL
The quasi-experimental design of the study by Dr. Reynolds and colleagues makes it difficult to draw solid conclusions about the best preschool programs for low-income children, writes David Olds, Ph.D., of the University of Colorado at Denver and Health Sciences Center in an accompanying editorial.
“To better estimate the impact of quality preschool programs and components of program quality, we need a well-funded programmatic series of randomized controlled trials,” Dr. Olds writes. “Funding such work will create a strong evidentiary foundation for improving intervention effectiveness and generate even greater policy support for quality preschool.”
“Some will argue that the quasi-experimental evidence on quality components is so strong that we don’t need randomized controlled trials to sort out these details; but with the quality of currently funded preschool programs so far below the standards embodied in the model programs on which the case for expanded preschool is based, we will need extraordinarily strong evidence to ensure that policymakers do not cave into pressures to serve larger numbers of children at a lower cost.”
(Arch Pediatr Adolesc Med. 2007;161(8):807-809. Available to the media pre-embargo 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.
EDITORIAL: EARLY-CHILDHOOD EDUCATION SHOULD MAKE SPACE FOR ALL
Despite studies like Dr. Reynolds’ that demonstrate the effectiveness of early childhood interventions, prisons are more likely to get adequate funding than preschools, writes James Forman Jr., J.D., of Georgetown Law School, Washington, D.C., in an additional accompanying editorial.
“In our country, when we run out of prison space, we simply build more,” he writes. “The result is that we have the highest incarceration rate in the world despite being the nation’s wealthiest country. Early-childhood education, on the other hand, is woefully under-funded.”
“The findings from the Child-Parent Centers should not surprise us,” he continues. “They prove that a well-designed and well-executed early-childhood education program can make a significant difference in the life outcomes of children from low-income households. They also show that no single intervention is enough: good early-childhood education needs to be accompanied by (among other things) adequate health care and needs to be followed by quality K-through-12 education.” Such programs could, among other benefits, reduce the number of prisons and prisoners in the United States, Forman concludes.
(Arch Pediatr Adolesc Med. 2007;161(8):809-810. Available to the media pre-embargo 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 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, August 6, 2007
Media Advisory: To contact Nora D. Volkow, M.D., call Dorie Hightower at 301-496-1545.
ADHD APPEARS TO BE ASSOCIATED WITH DEPRESSED DOPAMINE ACTIVITY IN THE BRAIN
CHICAGO—Adults with attention-deficit/hyperactivity disorder (ADHD) show a blunted response to the drug methylphenidate (Ritalin), which increases brain dopamine levels, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals. This suggests that dopamine dysfunction may be involved with ADHD symptoms and may contribute to substance abuse that often occurs simultaneously.
ADHD is the most prevalent psychiatric disorder among children, according to background information in the article. “Despite decades of research, the specific neurobiological mechanisms underlying this disorder still remain unclear,” the authors write. “Genetic, clinical and imaging studies point to a disruption of the brain dopamine system, which is corroborated by the clinical effectiveness of stimulant drugs (methylphenidate hydrochloride and amphetamine), which increase extracellular dopamine in the brain.”
Nora D. Volkow, M.D., of the National Institute on Drug Abuse, Bethesda, Md., and colleagues studied 19 adults with ADHD (average age 32) who had never received medication and 24 healthy controls (average age 30). Brain scans were performed using positron emission tomography (PET) and a drug known as raclopride labeled with carbon 11 ([11C]raclopride), which binds with dopamine receptors. Scans were performed twice, after injections of placebo and of methylphenidate; the participants did not know which drug they had received. Participants also were asked to report the severity of their ADHD symptoms, whether they could detect the drug, if they liked or disliked it, and if it made them feel “high,” tired, alert, anxious or restless.
In individuals with ADHD, methylphenidate caused less of a decrease in the amount of [11C]raclopride that bound to dopamine receptors in areas of the brain associated with attention than it did in those without ADHD. Since levels of methylphenidate in the blood were the same in both groups, this suggests that those with ADHD released less dopamine in response to the drug than controls. This blunted response was associated with symptoms of inattention. Exploratory analyses also found evidence of reduced [11C]raclopride binding in the hippocampus and amygdala in those with ADHD. These areas of the brain are part of the limbic system, involved in emotional responses as well as consolidating and retrieving memories.
“The findings of reduced dopamine release in subjects with ADHD are consistent with the notion that the ability of stimulant medications to enhance extracellular dopamine underlies their therapeutic effects in ADHD,” the authors write.
Individuals with ADHD also reported liking methylphenidate more than individuals without ADHD, the authors note. “The reinforcing responses to methylphenidate were negatively correlated with the dopamine increases, suggesting that decreased dopaminergic activity may also be involved in modulating the magnitude of the reinforcing effects of methylphenidate,” they continue. “This suggests that dopamine dysfunction is involved with symptoms of inattention but may also contribute to substance abuse comorbidity in ADHD.”
(Arch Gen Psychiatry. 2007;64(8):932-940. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported in part by the Intramural Research Program of the National Institutes of Health, a contract from the Department of Energy, and by a grant from the National Institute of Mental 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, August 6, 2007
Media Advisory: To contact Philip Shaw, M.D., Ph.D., call Jules Asher at 301-443-4536.
GENE VARIANT IS ASSOCIATED WITH BRAIN ANATOMY, CLINICAL COURSE OF ADHD
CHICAGO—A variant of the dopamine receptor gene may be associated with attention-deficit/hyperactivity disorder (ADHD) and with thinner tissue in areas of the brain that handle attention, but also appears associated with better clinical outcomes among individuals with the disorder, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
ADHD is among the most heritable of neuropsychiatric disorders, according to background information in the article. Several genes have been identified as possibly associated with the condition. One of the most frequently cited is a polymorphism or different type of the dopamine D4 receptor gene (DRD4) known as the 7-repeat form. “Previous studies have suggested that carriers of the risk allele [alternate form of a gene] may also have a unique neuropsychological, clinical and pharmacological profile, although there remains considerable debate over the exact nature of this phenotype [characteristic],” the authors write.
Philip Shaw, M.D., Ph.D., of the National Institute of Mental Health, Bethesda, Md., and colleagues compared 105 children with ADHD (average age 10.1) to 103 healthy controls, using both magnetic resonance imaging (MRI) and DNA testing. Sixty-seven (64 percent) of the children with ADHD also had a follow-up clinical evaluation an average of six years later.
Among all participants, both with and without ADHD, having the 7-repeat form of DRD4 was associated with thinner tissue in areas of the brain known to control attention—the right orbitofrontal/inferior prefrontal and posterior parietal cortex. Similar regions were also generally thinner in participants with ADHD than those without. “As a result of the overlapping main effects of genotype and diagnosis, there was a stepwise increment in cortical thickness in these regions, with subjects with ADHD with the DRD4 7-repeat allele having the thinnest cortex, followed by subjects with ADHD lacking the 7-repeat allele, healthy 7-repeat allele carriers and finally by healthy non-carriers,” the authors write.
Analyses of the children who participated in the follow-up revealed that the differences between the brain anatomy of those with and without the DRD4 7-repeat allele were most pronounced in early development and disappeared by late adolescence. Individuals with ADHD who carried the DRD4 7-repeat allele had better clinical outcomes and regained thickness in their right parietal cortex—a sign previously linked to better outcomes and that parallels ADHD’s natural history of improvement with age.
“Cross-sectional studies have found regional increases in cortical thickness to correlate with cognitive function, including enhanced verbal declarative and extinction memory, and with ‘fluid’ intelligence in older, healthy subjects,” the authors write. “In children, gains in verbal knowledge are mirrored by change in the cortical thickness of speech areas. While our current study demonstrates changes in cortical thickness and symptoms occurring in tandem, a future goal is to refine further our appreciation of cortical thickness by examining the links between this neuroanatomical variable and putative cognitive endophenotypes [invisible but measurable components on a disease pathway] for ADHD, such as response inhibition and working memory.”
(Arch Gen Psychiatry. 2007;64(8):921-931. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Intramural Research Program 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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