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, September 24, 2007)
ACUPUNCTURE TREATMENT MAY BE MORE EFFECTIVE THAN CONVENTIONAL THERAPY IN TREATING LOWER BACK PAIN, GERMAN STUDY FINDS
PREVENTIVE HEALTH EXAMINATIONS ACCOUNT FOR APPROXIMATELY 1 IN 12 OUTPATIENT VISITS AMONG U.S. ADULTS
BLACK PATIENTS WITH ASTHMA MAY FARE WORSE REGARDLESS OF DISEASE SEVERITY
HOSPITALIST CARE ASSOCIATED WITH SHORTER HOSPITAL STAYS FOR PATIENTS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 24, 2007
Media Advisory: To contact Heinz G. Endres, M.D., email: heinz.endres{at}ruhr-uni-bochum.de.
ACUPUNCTURE TREATMENT MAY BE MORE EFFECTIVE THAN CONVENTIONAL THERAPY IN TREATING LOWER BACK PAIN, GERMAN STUDY FINDS
CHICAGO—Six months of acupuncture treatment appears to be more effective than conventional therapy in treating low back pain, according to a study in the September 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, although the study suggests that both sham acupuncture and traditional Chinese verum acupuncture appear to be effective in treating low back pain.
“Low back pain is a common, impairing and disabling condition, often long-term, with an estimated lifetime prevalence of 70 percent to 85 percent,” the authors write as background information in the article. “It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability.” Acupuncture is increasingly used as an alternative therapy, but its value as a treatment for low back pain is still controversial.
Michael Haake, Ph.D., M.D., of the University of Regensburg, Bad Abbach, Germany, and colleagues conducted a randomized clinical trial involving 1,162 patients (average age 50) who had experienced chronic low back pain for an average of eight years. Patients underwent ten 30-minute sessions (approximately two sessions per week) of verum acupuncture (387 patients), sham acupuncture (387 patients) or conventional therapy (388 patients). Verum acupunture consisted of needling fixed points and additional points to a depth of 5 millimeters to 40 millimeters based on traditional Chinese medicine, while sham acupuncture consisted of inserting needles superficially (1 millimeter to 3 millimeters) into the lower back avoiding all known verum points or meridians. Conventional therapy consisted of a combination of medication, physical therapy and exercise. Five additional sessions were offered to those who had a partial response to treatment (10 percent to 50 percent pain reduction).
“A total of 13,475 treatment sessions were conducted (verum acupuncture, 4,821; sham acupuncture, 4,590; conventional therapy, 4,064),” the authors write. Patients receiving the additional five sessions were 232 (59.9 percent) in the verum group, 209 (54.3 percent) in the sham group and 192 (52.5 percent) in the conventional group.
Response rate was defined as a 33 percent improvement in pain or a 12 percent improvement in functional ability. “At six months, response rate was 47.6 percent in the verum acupuncture group, 44.2 percent in the sham acupuncture group and 27.4 percent in the conventional therapy group,” the authors note. “Differences among groups were as follows: verum vs. sham, 3.4 percent; verum vs. conventional therapy, 20.2 percent; and sham vs. conventional therapy, 16.8 percent.”
“The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,” the authors conclude. “Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment.”
(Arch Intern Med. 2007;167(17):1892-1898. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the following German public health insurance companies: Allgemeine Ortskrankenkasse, Betriebskrankenkasse, Innungskrankenkasse, Bundesknappschaft, Bundesverband der Landwirtschaftlichen Krankenkassen and Seekasse. 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, September 24, 2007
Media Advisory: To contact Ateev Mehrotra, M.D., M.P.H., call Wendy Zellner at 412-647-9944.
PREVENTIVE HEALTH EXAMINATIONS ACCOUNT FOR APPROXIMATELY 1 IN 12 OUTPATIENT VISITS AMONG U.S. ADULTS
CHICAGO—An estimated 63.5 million U.S. adults visited a physician for a preventive health or gynecological examination each year between 2002 and 2004, at an annual cost of approximately $7.8 billion, according to a report in the September 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“The value of many preventive health services is well established, but the role of preventive health examinations (PHEs) (also called periodic health evaluations) for health promotion and screening of disease risk factors and subclinical illness remains controversial,” the authors write as background information in the article. Two-thirds of patients and physicians believe it is important for patients to receive a yearly check-up; however, strictly preventive general health or gynecological examinations are not recommended by major North American clinical organizations.
Ateev Mehrotra, M.D., M.P.H., of the University of Pittsburgh School of Medicine and RAND Health, Pittsburgh, and colleagues analyzed data from a nationally representative survey of office-based physicians conducted between 2002 and 2004. Randomly selected physicians completed a one-page form detailing their encounters with each of 30 randomly selected patients during an assigned reporting week.
Over the three years of the survey, 181,173 outpatient visits occurred, of which 5,387 were preventive health examinations and 3,026 were preventive gynecological examinations. Nationwide, this is equivalent to 44.4 million adults (20.9 percent of the population) receiving preventive health examinations and 19.4 million women (17.7 percent of adult women) receiving preventive gynecological examinations each year.
The rates of preventive health examinations varied by region, with individuals in the Northeast 60 percent more likely to receive one than those in the West, and by insurance type, with the uninsured half as likely to receive one as those with private insurance or Medicare.
Preventive services such as mammograms, cholesterol screening and smoking cessation counseling were provided at 52.9 percent of preventive health examinations and 83.5 percent of preventive gynecological examinations. However, only 19.9 percent of eight preventive services were provided at these examinations as opposed to other types of physician visits. “For example, mammograms ordered at preventive health examinations and preventive gynecological examinations accounted for 22.9 percent and 44.7 percent of all mammograms, respectively,” the authors write. “In contrast, of all visits with weight reduction counseling, only 8.8 percent were preventive health examinations and 1.1 percent were preventive gynecological examinations.”
“Preventive health examinations and preventive gynecological examinations are among the most common reasons adults see a physician,” they conclude. “These visits frequently include preventive services, but most preventive services are provided at other visits. These findings provide a foundation for continuing national deliberations about the use and content of preventive health examinations and preventive gynecological examinations.”
(Arch Intern Med. 2007;167(17):1876-1883. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Dr. Mehrotra’s salary was supported by a National Research Service Award from the Health Resources and Services Administration. 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, September 24, 2007
Media Advisory: To contact Sara E. Erickson, M.D., call Corinna Kaarlela at 415-476-8254.
BLACK PATIENTS WITH ASTHMA MAY FARE WORSE REGARDLESS OF DISEASE SEVERITY
CHICAGO—Patients with asthma who are black appear more likely to visit the emergency department or be hospitalized for the condition than those who are white, even in a managed care setting that provides uniform access to care, according to a report in the September 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Research has shown that black patients with asthma have worse control of their symptoms and higher rates of hospitalization and death than white patients, according to background information in the article. Reasons may include inadequate access to health care, lower socioeconomic status, genetic or behavioral factors, suboptimal use of asthma control medications, environmental exposures and poor communication or racial bias among health care providers. Previous studies have adjusted for the effects of socioeconomic status and found that racial disparities in asthma outcomes persisted.
Sara E. Erickson, M.D., of the University of California, San Francisco, and colleagues studied 678 patients in one large health plan who were hospitalized for asthma between 2000 and 2004. The patients were interviewed after they were discharged to gather information about their disease and how it affected their lives, their health status and their socioeconomic status. U.S. Census data also was used to gather socioeconomic data from within one block of their home. The patients were followed up for a median (midpoint) of 1.9 years to see if they visited the emergency department or were readmitted to the hospital.
Of the patients included in the study, 524 were white and 154 were black. Although there was no difference between black and white patients in asthma severity, physical health status or controller medication use, blacks were significantly more likely than whites to have had outpatient visits related to their asthma during the study follow-up. Also during this time period, 35.7 percent of black patients compared with 21 percent of white patients visited the emergency department for asthma symptoms and 26.6 percent of blacks vs. 15.3 percent of whites were hospitalized for asthma. These associations remained when the researchers controlled for socioeconomic status and differences in asthma therapy.
“The reasons underlying the racial disparities observed in this study are not clear, although they are likely to be complex,” the authors write. Because knowledge of racial disparities is widespread, clinicians may be more likely to encourage black patients to seek emergency care for their asthma and emergency room physicians maybe more likely to admit blacks, they note. Alternatively, there may be differences in behavior or cultural beliefs about asthma, or in therapies not measured in this study.
“Even in a health care setting that provides uniform access to care, black race was associated with worse asthma outcomes, including a greater risk of emergency department visits and hospitalizations,” the authors conclude. “These findings suggest that genetic differences may underlie these racial disparities.”
(Arch Intern Med. 2007;167(17):1846-1852. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Heart, Lung and Blood Institute, 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, September 24, 2007
Media Advisory: To contact William N. Southern, M.D., M.S., call Mike Quane at 718-920-4011.
HOSPITALIST CARE ASSOCIATED WITH SHORTER HOSPITAL STAYS FOR PATIENTS
CHICAGO—Patients at an academic medical center who are cared for by a hospital-based general physician may have a shorter length of hospital stay than those who are not, especially if the patients require close monitoring or complex discharge planning, according to a report in the September 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Pressure to control costs has led more academic medical centers to hire hospital-based physicians, known as hospitalists, according to background information in the article. These clinicians provide care for medical inpatients and staff medical teaching rounds.
William N. Southern, M.D., M.S., and colleagues at Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, N.Y., reviewed data on all patients discharged from a 381-bed teaching hospital between July 1, 2002, and June 30, 2004. The patients were assigned to either a hospitalist or non-hospitalist team by a senior admitting resident at the time of admission. The teams were identical except for the type of physician conducting the rounds. Data on the patients’ demographics, insurance status, health history, diagnosis, length of stay, readmission and death were gathered form the hospital’s clinical information system.
During the study period, there were 9,037 discharges with sufficient data to be included in the analysis. Of these, 2,913 (32.2 percent) were cared for by hospitalists teams and 6,124 (67.8 percent) were cared for by non-hospitalist teams. The average length of stay in the hospitalist group was 5.01 days, compared with 5.87 days in the non-hospitalist group. There were no differences between the two groups in readmission or death rate in the hospital or within 30 days.
“Hospitalist care had the strongest association with length of stay in patients with specific diagnoses, including cerebrovascular accidents (strokes), congestive heart failure, pneumonia, sepsis, urinary tract infections and asthma/chronic obstructive pulmonary disease,” the authors write. “The close monitoring and continuous presence offered by hospitalists may allow for earlier discharge because hospitalists are more likely to detect clinical improvement in real time and to make appropriate adjustments in treatment regimens.”
Hospitalist care was also more strongly associated with shorter length of stay in patients who had complex discharge planning needs, such as home health care services, rehabilitation or transfer to a nursing facility. “We were able to measure discharge planning needs with the use of a separate discharge disposition code, which was assigned independent of billing at the time of discharge,” the authors write. “We believe that the greater reduction in length of stay associated with complex discharge planning reflects hospitalist skills in working with ancillary staff, such as social workers or discharge planners.”
(Arch Intern Med. 2007;167(17):1869-1874. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Institute for Medical Effectiveness Research, a joint project of the Albert Einstein College of Medicine and the North Shore–Long Island Jewish Health System, and the Clinical Investigation Core of the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center. 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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