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 GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 1, 2007)
COMBINATION OF MEDICATION AND PSYCHOTHERAPY APPEARS MOST EFFECTIVE FOR TREATMENT OF DEPRESSED TEENS
PANIC ATTACKS ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR EVENTS AND DEATH IN OLDER WOMEN
LOW LEVEL OF CONSCIENTIOUSNESS MAY BE A RISK FACTOR FOR ALZHEIMER'S DISEASE
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 1, 2007)
ALMOST ONE-THIRD OF U.S. CHILDREN REGULARLY TAKE DIETARY SUPPLEMENTS
BLOCK-PLAY MAY IMPROVE LANGUAGE DEVELOPMENT IN TODDLERS
POOR HEALTH CARE ACCESS COMMON AMONG YOUTH LEAVING FOSTER SYSTEM
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 1, 2007
Media Advisory: To contact corresponding author John S. March, M.D., M.P.H., call Melissa Schwarting at 919-660-1303.
COMBINATION OF MEDICATION AND PSYCHOTHERAPY APPEARS MOST EFFECTIVE FOR TREATMENT OF DEPRESSED TEENS
CHICAGO—The combination of the antidepressant medication fluoxetine and cognitive behavior therapy appears more effective than either strategy alone for the long-term treatment of adolescents with depression, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Major depressive disorder affects approximately 5 percent of adolescents, causing difficulties for patients and their families and increasing the risk for suicide, according to background information in the article. To improve the treatment of depression in teens, the National Institute of Mental Health (NIMH) in 1999 funded the Treatment for Adolescents with Depression Study (TADS). TADS is a randomized controlled trial evaluating short- and long-term effectiveness of three treatments: fluoxetine alone; cognitive behavior therapy, a type of psychotherapy addressing the way individuals currently think and act rather than past events; and a combination of the two.
The TADS team randomly assigned 439 adolescents with depression to one of the three treatments or to placebo pills for 12 weeks. At that point, patients receiving placebo were offered active treatment and the remaining 327 patients (average age 14.6) were asked to continue their assigned therapy through 36 weeks. Fluoxetine was initially prescribed at a dose of 10 milligrams per day; the dosage was increased or decreased at various points during the study based on whether patients responded to treatment or experienced adverse effects. Patients receiving cognitive behavioral therapy had fifteen one-hour sessions during the first 12 weeks, then less frequently, with exact timing dependent on how they responded to treatment.
After 12 weeks, 73 percent of patients receiving combination therapy, 62 percent of those receiving fluoxetine only and 48 percent of those undergoing cognitive behavior therapy only responded to treatment, as measured by two clinical scales. At the end of 36 weeks, 243 (74.3 percent) of the 327 patients remained in the study. Response rates were 86 percent for combination therapy, 81 percent for fluoxetine and 81 percent for cognitive behavioral therapy.
Throughout treatment, researchers monitored patients for suicidal thoughts and behaviors. At the beginning of the study, 42 of 106 (39.6 percent) of those in the combination therapy group, 28 of 107 (26.2 percent) of those in the fluoxetine group and 27 of 107 (25.2 percent) of those in the cognitive behavior therapy group warranted prompt evaluation for suicidal tendencies. By week 12, patients treated with fluoxetine alone reported more clinically significant suicidal thoughts and behaviors than those in either of the groups receiving cognitive behavior therapy. After 36 weeks, two of 79 (2.5 percent) combination therapy patients, 10 of 73 (13.7 percent) taking fluoxetine alone and three of 76 (3.9 percent) receiving cognitive behavior therapy reported experiencing significant suicidal thoughts and behaviors.
Suicidal events—defined as suicidal attempts, thoughts and behaviors or preparatory actions toward suicide—occurred in 10 percent of patients in the study, mostly early in treatment. "Patients treated with fluoxetine alone were twice as likely as patients treated with combination therapy or cognitive behavior therapy to experience a suicidal event, indicating that cognitive behavior therapy may protect against treatment-emergent suicidal events in patients taking fluoxetine," the authors write. "After taking benefit and risk into account, we conclude that the combination of fluoxetine and cognitive behavior therapy appears superior to either monotherapy [single treatment] as a long-term treatment strategy for major depressive disorder in adolescents."
(Arch Gen Psychiatry. 2007;64(10):1132-1144. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The TADS is supported by a contract from the NIMH to Duke University Medical Center. Eli Lilly and Company provided fluoxetine and matching placebo under an independent educational grant to Duke University. 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, October 1, 2007
Media Advisory: To contact Jordan W. Smoller, M.D., Sc.D., call Sue McGreevey at 617-724-2764.
PANIC ATTACKS ASSOCIATED WITH INCREASED RISK OF CARDIOVASCULAR EVENTS AND DEATH IN OLDER WOMEN
CHICAGO—Older women who experience at least one full-blown panic attack may have an increased risk of having a heart attack or stroke and an increased risk of death in the next five years, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Panic attacks involve the sudden development of fear, anxiety or extreme discomfort accompanied by four or more additional symptoms, according to background information in the article. They may occur sporadically or as part of an anxiety disorder, such as panic disorder, social anxiety disorder or phobias.
Jordan W. Smoller, M.D., Sc.D., of Massachusetts General Hospital, Boston, and colleagues studied 3,369 healthy postmenopausal women (age 51 to 83, average age 65.9). When they entered the study between 1997 and 2000, the women filled out a questionnaire about the occurrence of panic attacks in the previous six months. They were then followed for an average of 5.3 years to see whether they had a heart attack or stroke or died from any cause.
About 10 percent of the women reported having a full-blown panic attack in the six months prior to the study. After the researchers adjusted for other cardiovascular risk factors, having one or more panic attacks was associated with four times the risk of myocardial infarction (heart attack), three times the risk of having a heart attack or stroke and nearly twice the risk of death from any cause. These associations remained after controlling for depression, suggesting that panic attacks may be a separate, independent risk factor for cardiovascular events.
The results add panic attacks to the list of emotions and psychiatric symptoms that have already been linked to cardiovascular risk, including depression, anger and hostility, the authors note. Panic attacks could be associated with other cardiovascular risk factors, such as hypertension. Alternatively, anxiety could contribute to adverse cardiovascular effects, such as coronary artery spasm, tendency toward increased blood clotting or disturbances in heart rhythm.
"These results suggest that panic anxiety is a marker for increased risk of cardiovascular morbidity and mortality among postmenopausal women," the authors conclude. "Future studies are needed to clarify the causal connection, if any, between panic attacks and cardiovascular events. Our results imply, however, that older women with a recent history of panic attacks represent a subgroup at elevated risk of myocardial infarction and stroke in whom careful monitoring and cardiovascular risk reduction may be particularly important."
(Arch Gen Psychiatry. 2007;64(10):1153-1160. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The Women's Health Initiative program is funded by the National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services. The Myocardial Ischemia and Migraine Study was funded by Glaxo Wellcome (now GlaxoSmithKline). 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, October 1, 2007
Media Advisory: To contact Robert S. Wilson, Ph.D., call Kimberly Waterman at 312-942-7820.
LOW LEVEL OF CONSCIENTIOUSNESS MAY BE A RISK FACTOR FOR ALZHEIMER'S DISEASE
CHICAGO—Individuals who are more conscientious—in other words, those with a tendency to be self-disciplined, scrupulous and purposeful—appear less likely to develop Alzheimer's disease, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Conscientiousness refers to a person's tendency to control impulses and be goal-directed, and is also known as will, work and dependability, according to background information in the article. It has been associated with a wide range of mental and physical disorders, disability and death, suggesting it may be important for maintaining overall health.
Robert S. Wilson, Ph.D., of Rush University Medical Center, Chicago, and colleagues studied 997 older Catholic nuns, priests and brothers who did not have dementia when the study began in 1994. Participants underwent evaluations that included medical history, neurologic examinations and cognitive testing. Conscientiousness was measured with a 12-item inventory, where participants rated agreement with each item (for example, "I am a productive person who always gets the job done") on a scale of one to five. Scores ranged from zero to 48, with higher scores indicating more conscientiousness. The researchers conducted follow-up examinations annually through 2006, with an average of 7.9 evaluations per person.
The participants had an average conscientiousness score of 34 out of 48. Through a maximum of 12 years of follow-up, 176 individuals developed Alzheimer's disease. Those who had conscientiousness scores in the 90th percentile (40 points) or higher had an 89 percent lower risk of developing Alzheimer's disease than those whose scores ranked in the 10th percentile (28 points) or lower. Controlling for known Alzheimer's disease risk factors did not substantially change these results. Conscientiousness also was associated with a slower rate of cognitive decline and a lower risk of mild cognitive impairment, a condition that may precede Alzheimer's disease.
The researchers also analyzed results from brain autopsies of 324 participants who died during the study. In these patients, conscientiousness was not linked to any of the hallmark signs of Alzheimer's disease, including brain plaques and tangles. However, conscientiousness did appear to modify the association of these brain changes with an individual's cognitive abilities before death.
There are several ways by which conscientiousness might protect against Alzheimer's disease, the authors write. First, conscientious individuals may be more likely to experience educational or occupational success, both of which have been associated with a reduced risk of Alzheimer's disease. In addition, conscientiousness has been linked to resilience and to coping actively with difficulties. "These factors might lessen the adverse consequences of negative life events and chronic psychological distress, which have been associated with risk of dementia in old age," the authors note.
"In conclusion, level of conscientiousness is associated with incidence of mild cognitive impairment and Alzheimer's disease but not with the pathologic hallmarks of these conditions," they continue. "Understanding the mechanisms linking conscientiousness to maintenance of cognition in old age may suggest novel strategies for delaying the symptoms of Alzheimer's disease."
(Arch Gen Psychiatry. 2007;64(10):1204-1212. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by grants from the National Institute on Aging. 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, October 1, 2007
Media Advisory: To contact Mary Frances Picciano, Ph.D., call Kelli Marciel at 301-496-4819.
ALMOST ONE-THIRD OF U.S. CHILDREN REGULARLY TAKE DIETARY SUPPLEMENTS
CHICAGO—More than 30 percent of American children age 18 and younger take some form of dietary supplement, most often multivitamins and multiminerals, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Most U.S. adults—including 57 percent of women and 47 percent of men—take dietary supplements, according to background information in the article. Professional organizations emphasize diet as the best source of nutrients for children; however, physicians may recommend supplements for certain children at risk of deficiency.
Mary Frances Picciano, Ph.D., of the Office of Dietary Supplements, National Institutes of Health, Bethesda, Md., and colleagues analyzed data from the 1999 to 2002 National Health and Nutrition Examination Survey. This nationally representative survey included 10,136 children age 18 or younger. Participants were given medical examinations and families were interviewed, usually at home.
The researchers found that:
- 31.8 percent of children had used dietary supplements in the previous 30 days, including 11.9 percent of infants younger than 1 year, 38.4 percent of children age 1 to 3 years, 40.6 percent of 4- to 8-year-old children, 28.9 percent of 9- to 13-year-olds and 25.7 percent of teenagers 14 to 18 years
- more non-Hispanic white (38.3 percent) and Mexican American (22.4 percent) children used supplements than non-Hispanic black participants (18.8 percent)
- multivitamins and multiminerals (18.3 percent) were the most commonly used supplements, followed by single vitamins (4.2 percent), single minerals (2.4 percent) and botanical supplements (0.8 percent)
- children who took supplements at all during the previous 30 days took them regularly, with more than 50 percent having taken a supplement 30 times in the past month and more than 60 percent having taken supplements for at least 12 months
- supplement use was associated with higher family income, a smoke-free environment, lower body mass index in children and less daily television, video game or computer time
- children who were underweight or at risk for being underweight were the most likely to take supplements
- 83.9 percent of those who took any supplements took only one, 11.8 percent took two and 4.3 percent took three or more
"In conclusion, dietary supplements provide a consistent daily source of nutrients for nearly one-third of U.S. children, yet individual and national-level estimates of nutrient intake rarely account for them," the authors write. "Dietary Reference Intakes and Dietary Guidelines for Americans provide recommended nutrient intakes and advice on food choices that promote health and reduce the risk of disease. To truly assess the nutrient status and estimate the potential health risks of U.S. children, we must include nutrient intakes from dietary supplements as well as from food."
(Arch Pediatr Adolesc Med. 2007;161(10):978-985. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded in full by the Office of Dietary Supplements at the National Institutes of Health via a contract with RTI International. 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, October 1, 2007
Media Advisory: To contact Dimitri A. Christakis, M.D., M.P.H., call Teri Thomas at 206-987-5213.
BLOCK-PLAY MAY IMPROVE LANGUAGE DEVELOPMENT IN TODDLERS
CHICAGO—Playing with toy blocks may lead to improved language development in middle- and low-income children, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
"Early childhood represents a critical period in the development of young minds," according to background information in the article. "The newborn brain triples in size between birth and 2 years of age. The long-standing presumption has been that certain activities during this period promote optimal development and that others may hinder it." The development of memory and the roots of impulse control and language can be acquired through imaginative play. Many toys today claim to improve children's cognitive development. However, most such claims are unsubstantiated.
Dimitri A. Christakis, M.D., M.P.H, of the University of Washington, Seattle and the Seattle Children's Hospital Research Institute, and colleagues conducted a pilot study involving 175 children age 1.5 to 2.5 years. One group of 88 children was mailed two sets of building blocks and two newsletters with suggestions for parents about activities that families could do with the blocks (for example, sorting them by color). The other group of 87 children did not receive any blocks until after the conclusion of the study. Parents, who were told only that they were participating in a study of child time use, completed a questionnaire about basic demographic information at the beginning of the study and provided time diaries that tracked the activities of their child during two 24-hour periods during the trial. Parents completed another questionnaire by telephone six months after enrollment that included assessments of their children's language and attention.
Ninety-two families (53 percent) returned at least one diary entry and exit interviews were completed by 140 families (80 percent). Of those who received the two sets of blocks during the study, 52 (59 percent) had block-play reported in their diaries compared with only 11 (13 percent) of those in the other group.
"In this pilot study, we found that distributing blocks was associated with significantly higher language scores in a sample of middle- and low-income children," the authors write. On average, children who received blocks score 15 percent higher on their language assessment than those who did not. The results suggest that a program that distributes blocks may be effective in promoting development. There was no difference found in attention scores between the two study groups.
The researchers speculate that the distribution of toy blocks resulted in more block-play (based on diary entries) and that this block playtime may be replacing other forms of time use that do not encourage language development. Television time may have also been replaced by block-play.
"Further study (including laboratory assessments) to corroborate these findings and to explore whether attentional capacity could be significantly improved given a larger sample is warranted."
(Arch Pediatr Adolesc Med. 2007;161(10):967-971. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was funded by Mega Bloks, which provided research support and the blocks themselves. 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, October 1, 2007
Media Advisory: To contact Margot B. Kushel, M.D., call Phyllis Brown at 415-476-2557. To contact corresponding editorialist Peter J. Pecora, Ph.D., call Candice Douglass at 425-214-2704.
POOR HEALTH CARE ACCESS COMMON AMONG YOUTH LEAVING FOSTER SYSTEM
CHICAGO—Youth who have been homeless for any period of time after leaving the foster care system appear to have more problems accessing health care than those with stable housing situations, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
About 20,000 of the 550,000 children in the U.S. foster care system are emancipated or released from the system due to age each year, according to background information in the article. "These youth are at high risk of homelessness and have poor health outcomes, including high rates of drug and alcohol use, unplanned pregnancies and poor mental health outcomes," the authors write. "Approximately 40 percent of homeless adults aged 18 to 20 years were in the foster care system as youth."
Margot B. Kushel, M.D., of the University of California, San Francisco, and San Francisco General Hospital, and colleagues in 2002 to 2003 interviewed 749 foster youth age 17 or 18 in Illinois, Wisconsin or Iowa. One year later, 643 youth completed a follow-up interview. On both occasions, participants were asked about their sociodemographics, access to health care, housing situation and physical and mental health status.
At the second interview, about half (45.7 percent) of the participants were still in the foster care system and the rest were emancipated. Among those who had left the system, 14.2 percent had experienced homelessness and 39.4 percent had unstable housing situations, meaning that since emancipation they had moved three or more times or that they spent more than 50 percent of their income on rent.
"We found high rates of poor access to health care among all emancipated youth, with an experience of homelessness being associated with significantly higher odds of being uninsured and of having unmet need for health care," the authors write.
"While approximately 30 percent of young adults in the general population report an episode of being uninsured over the course of the past year, we found that more than half of emancipated participants were uninsured, with rates ranging from 46.5 percent of the stably housed to 76.6 percent of the participants with an experience of homelessness. More than one-fifth (22 percent) of emancipated participants reported unmet need for medical care (14.5 percent of stably housed youth, up to 40.8 percent of those with homelessness) compared with approximately 12 percent of young adults in the general population."
Overall, 12.1 percent of the participants had fair or poor (rather than good or excellent) health status, with no significant differences based on housing status. This compares with less than 4 percent of all adults of a similar age.
"Recently emancipated foster youth are at high risk for poor housing and poor health care access, which are associated with one another," the authors conclude. "Strategies to improve health outcomes among emancipated youth should address both their lack of health insurance and their risk of housing instability and homelessness."
(Arch Pediatr Adolesc Med. 2007;161(10):986-993. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Dr. Kushel was supported by the Stuart Foundation, the Agency for Healthcare Research and Quality, and by the Hellman Family Award for early career development. Co-author Dr. Yen was supported by the Stuart Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PROVIDING BETTER OPPORTUNITIES FOR YOUTH LEAVING FOSTER CARE
"The available research indicates that youth transitioning from foster care are likely to experience a number of negative outcomes in addition to homelessness," write Peter J. Pecora, Ph.D., and Tiffany Washington, M.S., of Casey Family Programs, Seattle, in an accompanying editorial.
"To make a difference in these young people's lives, programs must provide them with age-appropriate life skills, more stable environments with ties to the local community, and contact with as many birth-family or clan members as possible," they conclude. "It makes no sense to spend tens of thousands of dollars to care for young people during childhood, only to ignore their developmental needs and abandon them as young adults."
(Arch Pediatr Adolesc Med. 2007;161(10):1006-1008. 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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