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, September 3, 2007)
RESEARCHERS ESTIMATE ABOUT 9% OF U.S. CHILDREN AGE 8 TO 15 MEET CRITERIA FOR HAVING ADHD
TEENS WHO SEE MORE SMOKING IN MOVIES MAY HAVE INCREASED RISK OF BECOMING ESTABLISHED SMOKERS
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 3, 2007)
STUDY DOCUMENTS RAPID INCREASE IN YOUTH BIPOLAR DISORDER DIAGNOSES
FAMILY-BASED TREATMENT MORE EFFECTIVE THAN SUPPORTIVE PSYCHOTHERAPY IN TREATING BULIMIA
ADULT OFFSPRING OF PARENTS WITH PTSD HAVE LOWER CORTISOL LEVELS
TREATING DEPRESSION MAY IMPROVE RECOVERY OF HEART RATE VARIABILITY FOLLOWING CORONARY SYNDROMES
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, September 3, 2007
Media Advisory: To contact Tanya E. Froehlich, M.D., call Jim Feuer at 513-636-4656.
RESEARCHERS ESTIMATE ABOUT 9% OF U.S. CHILDREN AGE 8 TO 15 MEET CRITERIA FOR HAVING ADHD
CHICAGO—An estimated 8.7 percent of U.S. children age 8 to 15 meet diagnostic criteria for attention-deficit/hyperactivity disorder, but fewer than half receive treatment, according to a report in the September issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Despite widespread concern that the rate of attention-deficit/hyperactivity disorder (ADHD) is on the rise, the national population-based prevalence of ADHD in U.S. children has not been firmly established,” the authors write as background information in the article. ADHD is characterized by hyperactivity, impulsive behavior and an inability to pay attention to tasks; the condition affects social behaviors and achievement at school and work.
Tanya E. Froehlich, M.D., of Cincinnati Children’s Hospital Medical Center, and colleagues studied a group of 3,082 children designed to represent the entire population of 8- to 15-year-olds in the United States. Between 2001 and 2004, children’s parents or other caregivers were interviewed by phone and provided information about each child’s ADHD symptoms, including when they first appeared and any impairment they caused during the previous year. They also reported whether their child had ever been diagnosed with ADHD or taken medicine to treat it, in addition to providing sociodemographic details.
Based on standard diagnostic criteria, 8.7 percent of the children (equivalent to 2.4 million children nationwide) fulfilled criteria for ADHD in the year prior to the survey. Hispanics were less likely than whites to have ADHD and boys were more likely than girls to meet criteria, although girls who did have ADHD were less likely to have their condition recognized. A total of 47.9 percent of the children who met ADHD criteria had previously been diagnosed with the condition.
The poorest one-fifth of children were more likely than the wealthiest one-fifth of children to have ADHD. “Reasons for the increased likelihood of ADHD in poorer children may include the elevated prevalence of ADHD risk factors (i.e., premature birth and in utero or childhood exposures to toxic substances) in this group,” the authors write. “In addition, given the high heritability of ADHD and its negative impact on social, academic and career outcomes, it is plausible that families with ADHD may cluster within the lower socioeconomic strata.”
Among children meeting criteria for ADHD, 39 percent had received some medication treatment and 32 percent were treated consistently with ADHD medications during the previous year. Despite the prevalence of ADHD in poorer children, they were least likely to receive medications consistently. This finding “warrants further investigation and possible intervention to ensure that all children with ADHD have equitable access to treatment when appropriate,” the authors conclude.
(Arch Pediatr Adolesc Med. 2007;161(9):857-864. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the Ambulatory Pediatrics Association Young Investigator Grant, a National Research Service Award grant, a grant from the National Institutes of Health and a Robert Wood Johnson Generalist Physician Faculty Scholars Award. 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, September 3, 2007
Media Advisory: To contact James D. Sargent, M.D., call Jason Aldous at 603-653-1913.
TEENS WHO SEE MORE SMOKING IN MOVIES MAY HAVE INCREASED RISK OF BECOMING ESTABLISHED SMOKERS
CHICAGO—Exposure to smoking in movies appears to be associated with adolescents’ risk of becoming established smokers who have used at least 100 cigarettes in their lifetimes, according to a report in the September issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Previous studies have found that more exposure to movie smoking increases teens’ risk of starting to smoke, according to background information in the article. “However, not all adolescents who try smoking go on to become dependent smokers; half of high school seniors have tried smoking at some time, but only 7 percent are current daily smokers of half a pack or more,” the authors write. “Little is known about the factors that discriminate adolescents who progress to dependent smoking from those who do not.”
James D. Sargent, M.D., of Dartmouth Medical School, Lebanon, N.H., and colleagues surveyed 6,522 U.S. adolescents age 10 to 14 about their smoking and movie-watching habits in 2003. The researchers coded displays of smoking in 532 hit movies in the five years prior to the survey, then asked the teens if they had seen a random selection of 50 of these movies. They then created a measure of smoking exposure by adding the number of smoking occurrences in the portion of those 50 movies that the participant had seen, dividing by the number of occurrences in the 50 movies, and multiplying that by the number of smoking episodes in all 532 movies. Follow-up interviews to reassess smoking status were conducted after eight months, 16 months and two years.
At the beginning of the study, 5,637 (90 percent) of the teens had never smoked, while 33 (0.5 percent) had smoked more than 100 cigarettes. By the two-year follow-up survey, 125 of the participants had become established smokers. Adolescents who were below the midpoint of movie smoking exposure were less likely than teens who were above the midpoint to have smoked more than 100 cigarettes. The association remained significant after the researchers considered other factors related to teen smoking, including age, smoking by a parent or friend and sensation-seeking qualities.
The exact mechanism for this link is unclear, the authors note. “The context of current theory and research suggests the most plausible explanation is that frequent exposure to smoking cues in movies leads to more positive expectancies about effects of smoking, more favorable perceptions of smokers and a greater tendency to affiliate with teens who smoke, all factors that increase risk for smoking,” they write.
“Combined with previous findings showing that young persons who view more smoking in movies are at increased risk for initiating cigarette smoking, the present findings heighten concern about the public health implications of movie-smoking exposure by linking it with an outcome that predicts smoking-related morbidity and mortality in the future,” the authors conclude.
(Arch Pediatr Adolesc Med. 2007;161(9):849-856. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by a grant from the National Cancer Institute, the American Legacy Foundation and a grant from the National Institute on Drug Abuse. 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, September 3, 2007
Media Advisory: To contact corresponding author Mark Olfson, M.D., M.P.H., call Dacia Morris at 212-543-5421.
STUDY DOCUMENTS RAPID INCREASE IN YOUTH BIPOLAR DISORDER DIAGNOSES
CHICAGO—The estimated number of youth with office visits with a diagnosis of bipolar disorder substantially increased between 1994 and 2003, while adult visits with a bipolar disorder diagnoses appeared to almost double, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Bipolar disorder is a psychiatric illness that typically involves periods of mania (an abnormally elevated mood) and depression. “Although bipolar disorder may have its onset during childhood, little is known about national trends in the diagnosis and management of bipolar disorder in young people,” the authors write as background information in the article.
Carmen Moreno, M.D., of the Hospital General Universitario Gregorio Maranon, Servicio de Psiquiatria, Madrid, Spain, and colleagues analyzed data from a national survey of office-based physicians designed to represent all such clinicians in the United States. The physicians provided information about demographic, clinical and treatment aspects of each patient visit for a one-week time period. The researchers compared the rate of growth in bipolar disorder diagnoses among individuals age 19 and under to that of individuals age 20 and older from 1994 to 1995 through 2002 to 2003. They also compared demographic information and prescribed treatments between the two groups during the years 1999 to 2003.
The annual number of office-based visits with a diagnosis of bipolar disorder in youth was estimated to increase from 25 per 100,000 youth in 1994 to 1995 to 1,003 per 100,000 youth in 2002 to 2003. In the same time, outpatient visits with a diagnosis of bipolar disorder in adults increased from 905 to 1,679 per 100,000 population. As a percentage of total office-based visits, visits with a diagnosis of bipolar disorder increased among youth from 0.01 percent (1994 to 1995) to 0.44 percent (2002 to 2003), and among adults, from 0.31 percent to 0.5 percent in the same time periods.
Between 1999 and 2003, most young people diagnosed with bipolar disorder were male (66.5 percent), while 67.6 percent of diagnosed adults were females. Young people were more likely than adults to receive diagnoses of both bipolar disorder and attention-deficit/hyperactivity disorder (32.2 percent vs. 3 percent).
“The impressive increase in the diagnosis of childhood and adolescent bipolar disorder in U.S. office-based practice indicates a shift in clinical diagnostic practices,” the authors write. “In broad terms, either bipolar disorder was historically underdiagnosed in children and adolescents and that problem has now been rectified, or bipolar disorder is currently being overdiagnosed in this age group. Without independent systematic diagnostic assessments, we cannot confidently select between these two competing hypotheses.”
Most youth (90.6 percent) and adults (86.4 percent) were prescribed medications to treat bipolar disorder, including mood stabilizers, antipsychotics and antidepressants. These similarities occurred despite the fact that the condition and treatments may affect adults and children differently, the authors note. “There is an urgent need to study the reliability and validity using multiple informant strategies of the diagnosis of child and adolescent bipolar disorder in community practice and to evaluate the effectiveness and safety of pharmacological treatment regimens commonly used to treat youth diagnosed with bipolar disorder,” they conclude.
(Arch Gen Psychiatry. 2007;64(9):1032-1039. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 3, 2007
Media Advisory: To contact Daniel le Grange, Ph.D., call Scot Roskelley at 773-795-0892 or 773-470-5200.
FAMILY-BASED TREATMENT MORE EFFECTIVE THAN SUPPORTIVE PSYCHOTHERAPY IN TREATING BULIMIA
CHICAGO—Bulimia patients age 12 to 19 years who received family-based treatment were less likely to continue to binge and purge than those who received supportive psychotherapy, which explores the underlying issues of the disorder, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
“Bulimia nervosa (BN) is a disabling eating disorder with a prevalence of 1 percent to 2 percent among adolescents, while another 2 percent to 3 percent of adolescents present with bulimic symptoms that are clinically significant but do not meet full threshold criteria,” according to background information in the article. The disorder is characterized by episodes of excessive eating, or bingeing, combined with inappropriate weight loss methods, such as purging (vomiting), using laxatives or exercising obsessively.
Daniel le Grange, Ph.D., of the University of Chicago, and colleagues analyzed 80 patients (age 12 to 19, average age 16.1), 37 with bulimia and 43 with bulimic symptoms. Between 2001 and 2006, 41 were randomly assigned to family-based treatment and 39 to supportive psychotherapy. Family-based treatment involves parents, does not address underlying causes of the condition, seeks to separate bulimics from their symptoms and empowers them to change their behaviors. Supportive psychotherapy does not contain active advice on changing eating patterns, but instead helps patients resolve underlying emotional issues at the root of the disorder. The patients each attended 20 outpatient visits over six months and were assessed before treatment, midway through, immediately following and at six months after treatment.
More patients receiving family-based treatment (16, or 39 percent) than supportive psychotherapy (7, or 18 percent) achieved remission—defined as abstaining from binge eating and compensatory behavior, such as purging—immediately following treatment. “Somewhat fewer patients were abstinent at the six-month follow-up; however, the difference was statistically in favor of family-based treatment vs. supportive psychotherapy (12 patients [29 percent] vs. 4 patients [10 percent]),” the authors write.
“Results suggest that family-based treatment for bulimia nervosa is promising in the amelioration of symptomatic behavior for this disorder,” the authors conclude. “However, we do not know whether it is family involvement or the focus on eating behavior that is key to good treatment outcome. Moreover, abstinence rates between 30 percent and 40 percent leave considerable room for improvement.”
(Arch Gen Psychiatry. 2007;64(9):1049-1056. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Institute of Mental Health (Dr. le Grange). 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, September 3, 2007
Media Advisory: To contact Rachel Yehuda, Ph.D., call Jim Connell at 718-584-9000, ext. 6620.
ADULT OFFSPRING OF PARENTS WITH PTSD HAVE LOWER CORTISOL LEVELS
CHICAGO—A small study suggests that adults whose parents are Holocaust survivors with post-traumatic stress disorder (PTSD) appear to have lower average levels of the stress hormone cortisol than the adult offspring of parents without PTSD, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Biological differences seen in individuals with PTSD, including low cortisol levels, could either result from exposure to a traumatic event or could be present before such an event and predispose patients to the condition, according to background information in the article. “Once identified, such risk factors may prove to be useful as predictors of who will develop PTSD after exposure to trauma, or they may even identify potential new targets for prophylaxis [preventive therapy] and treatment,” the authors write.
Rachel Yehuda, Ph.D., of the Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, Bronx, New York, and colleagues studied 33 individuals whose parents had survived the Holocaust. These study participants were further divided into groups based on whether at least one parent met criteria for PTSD according to a questionnaire completed by the offspring. Twenty-three of the offspring had parents with PTSD, and 10 had parents without PTSD. The researchers measured the participants’ blood cortisol levels every 30 minutes for a 24-hour period, then compared them with the levels of 16 individuals whose parents were not Holocaust survivors. None of the participants had PTSD at the time of the study.
Individuals whose parents had PTSD displayed lower average cortisol levels over the 24-hour period than did those whose parents did not have PTSD or were not exposed to traumatic events. This decrease seemed specifically related to having a mother with PTSD.
“Offspring with parental PTSD also demonstrated changes in some chronobiological parameters previously identified as altered in trauma survivors with PTSD despite that no subject had PTSD at assessment,” the authors write. “However, the overall pattern of alterations observed in the offspring with parental PTSD did not follow that reported for PTSD, allowing differentiation between parameters associated with risk vs. those associated with PTSD pathogenesis [development].”
“Although the implications for PTSD prophylaxis cannot be specified from these results, they have clear clinical applications, including assessment of parental PTSD in patients with PTSD and evaluation of stressful events during pregnancy and early childhood,” the authors conclude. “Indeed, the data suggest that examination of epigenetic [environmental or other effect that does not change DNA] or in utero phenomena should be added to the search for genetic polymorphisms that may underlie individual differences that increase vulnerability to this disorder.”
(Arch Gen Psychiatry. 2007;64(9):1040-1048. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was supported by a grant from the National Institute of Mental Health and in part by a grant for the Mount Sinai General Clinical Research Center from 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 3, 2007
Media Advisory: To contact Alexander H. Glassman, M.D., call Dacia Morris at 212-543-5421.
TREATING DEPRESSION MAY IMPROVE RECOVERY OF HEART RATE VARIABILITY FOLLOWING CORONARY SYNDROMES
CHICAGO—Patients with depression appear to have an impaired ability to recover their heart rate variability following acute coronary syndromes such as heart attack, a factor that could increase their risk of coronary death, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals. However, patients who are treated with antidepressants or whose mood lifts may experience more of an improvement in heart rate variability than those who are untreated or remain depressed.
Heart rate variability refers to the degree to which the heart rate changes from beat to beat in response to normal impulses. “Low heart rate variability predicts death after myocardial infarction [heart attack],” the authors write as background information in the article. “It is reduced in depressed compared with non-depressed patients after myocardial infarction and has been proposed to be a mediator of the increased mortality associated with depression.” In non-depressed patients who have an acute coronary episode, heart rate variability drops and then recovers substantially but not completely during the next few months.
Alexander H. Glassman, M.D., of the Columbia University College of Physicians and Surgeons and the New York State Psychiatric Institute, New York, and colleagues measured heart rate variability in 290 depressed patients an average of three weeks after they were hospitalized for acute coronary syndrome, a term encompassing heart events such as heart attack. The patients were then randomly assigned to take either the antidepressant sertraline or placebo for 24 weeks. After 16 weeks, 258 patients returned for a second heart rate variability reading. The severity of each participants’ depression and their clinical response to depression treatment also were measured on previously established scales.
At the beginning of the study, previous episodes of depression were associated with lower heart rate variability. At the 16-week follow-up visit, the depressed patients had recovered their heart rate variability more slowly than expected and some even experienced a decrease. Patients who took sertraline had a 9 percent increase in heart rate variability and patients who took placebo had a 10 percent decrease, compared with the 28 to 33 percent increase in recovery of heart rate variability observed in previous studies of non-depressed patients.
“Both sertraline treatment and symptomatic recovery from depression were associated with increased heart rate variability compared with placebo-treated and non-recovered post–acute coronary syndrome control groups, respectively, but this results primarily from decreased heart rate variability in the comparison groups,” the authors write.
The mechanisms behind the relationship between heart rate variability, depression and cardiac death remain unclear, the authors note. “What is clear is that depression is associated with biological changes involving increased heart rate, inflammatory response, plasma norepinephrine, platelet reactivity, decreased heart rate variability and now absent post–acute coronary syndrome heart rate variability recovery, all of which is associated with life-threatening consequences. Understanding why these characteristics so strongly associate with depression is crucial to understanding the nature of depression itself,” they conclude.
“From a clinician’s point of view, patients with depression after myocardial infarction, especially those with prior episodes, should be both carefully watched and aggressively treated, because they are at an elevated cardiac risk and less likely to get better spontaneously.”
(Arch Gen Psychiatry. 2007;64(9):1025-1031. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a NARSAD Distinguished Investigator Award, the Suzanne C. Murphy Foundation, the Thomas and Caroline Royster Research Fund and Pfizer. 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.
