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, October 8, 2007)
NEGATIVE ASPECTS OF CLOSE RELATIONSHIPS MAY BE ASSOCIATED WITH HEART DISEASE RISK
SWISS STUDY SUGGESTS SURGERY MAY OFFER BEST CHANCE OF LONG-TERM PROSTATE CANCER SURVIVAL
HOSPITALIZED PATIENTS WITH PNEUMONIA WHO PREVIOUSLY RECEIVED PNEUMOCOCCAL VACCINE HAVE LOWER RATE OF DEATH OR ICU ADMISSION
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 8, 2007)
RELATIVES OF PATIENTS WITH PARKINSON’S DISEASE HAVE INCREASED RISK OF DEVELOPING DEMENTIA OR COGNITIVE IMPAIRMENT
CENTRAL NERVOUS SYSTEM INFECTIONS RARE BUT DEVASTATING FOLLOWING HEART TRANSPLANTATION
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 8, 2007)
ELEVATED LEVELS OF INFLAMMATORY MARKER MAY BE ASSOCIATED WITH INCREASED RISK OF AGE-RELATED EYE DISEASE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 8, 2007
Media Advisory: To contact Roberto De Vogli, Ph.D., M.P.H., e-mail: r.devogli{at}ucl.ac.uk.
NEGATIVE ASPECTS OF CLOSE RELATIONSHIPS MAY BE ASSOCIATED WITH HEART DISEASE RISK
CHICAGO—Individuals whose close relationships have negative aspects, such as conflict and adverse exchanges, appear to have an increased risk of heart disease than those with more positive close relationships, according to a report in the Oct. 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"An extensive body of research shows that social relations are associated with better health and reduced risks of cardiovascular disease," the authors write as background information in the article. "However, contradictory findings on the health benefits of structural support and the limited protective effect of marital status against cardiovascular disease among women have stimulated further scientific inquiry into the quality of social relationships."
Roberto De Vogli, Ph.D., M.P.H., and colleagues at University College London studied 9,011 British civil servants who completed a questionnaire about negative aspects of their close relationships either between 1989 and 1990 or between 1985 and 1988. Although the questionnaire assessed up to four close relationships, the researchers focused specifically on the primary close relationship. In addition, participants answered questions about how much emotional and practical support they received from that person on a regular basis. They were then followed for an average of 12.2 years to see if they experienced fatal or non-fatal coronary events, including heart attacks or chest pain.
Of the 8,499 individuals who did not have coronary heart disease at the beginning of the study and who provided sufficient information for the analysis, 589 reported a coronary heart disease event. After adjusting for other factors that influence heart disease risk—such as sociodemographic characteristics and health habits—those who experienced a high level of negativity in their close relationships were 1.34 times more likely to experience a coronary heart disease event than those with a low level of negative close relationships.
The association was weakened somewhat but still significant after the researchers adjusted for negative personality traits and depression. This suggests that emotions may partially mediate the association between negative relationships and heart disease. "When one considers emotional factors and their biological translation into the body, research shows that negative marital interactions are associated with depression, often in combination with reduced self-esteem and/or higher levels of anger," the authors write. "These emotional reactions have been found to influence coronary heart disease through the cumulative ‘wear and tear’ on organs and tissues caused by the alterations of autonomic [involuntary] functions, neuroendocrine changes, disturbances in coagulation [blood clotting] and inflammatory and immune responses."
Although women and those in lower employment grades were more likely to experience negative relationships, the associations with heart disease did not change based on sex or social position. In addition, heart disease risk was not associated with the level of emotional or practical support received. "It is possible that negative aspects of close relationships are more important for the health of individuals because of the power of negative close relationships to activate stronger emotions (worrying and anxiety) and the consequent physiological effects," the authors write. "In contrast, other more positive forms of support may not affect the physiology of individuals in a measurable or clinically relevant way."
(Arch Intern Med. 2007;167(18):1951-1957. 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 8, 2007
Media Advisory: To contact corresponding author Christine Bouchardy, M.D., M.P.H., e-mail: christine.bouchardymagnin{at}imsp.unige.ch.
SWISS STUDY SUGGESTS SURGERY MAY OFFER BEST CHANCE OF LONG-TERM PROSTATE CANCER SURVIVAL
CHICAGO—A study from Switzerland suggests that men who have surgery for prostate cancer appear less likely to die of the disease within 10 years than men who choose other treatment options, especially if they are younger or have cancers with certain tumor cell characteristics, according to a report in the Oct. 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Prostate cancer treatments are still being debated because they have not yet been compared in a randomized trial, in which men would be randomly assigned to one treatment or another, according to background information in the article. "Therefore, treatment choice is strongly influenced by patient and physician personal preferences and experiences," the authors write.
Arnaud Merglen, M.D., of Geneva University, Switzerland, and colleagues used data from the Geneva Cancer Registry to assess all 844 patients diagnosed with localized (not yet spread) prostate cancer in Geneva between 1989 and 1998. Of those men, 158 received prostatectomy, or surgery to remove all or part of the prostate; 205 had radiation treatment (radiotherapy); 378 chose watchful waiting, which entails active follow-up and treatment if the disease progresses; 72 underwent hormone therapy; and 31 had another type of therapy.
The average follow-up was 6.7 years (range zero to 15.8 years), and 47 patients (5.6 percent) left Geneva and the study before the study concluded.
"At 10 years, patients treated with radiotherapy or watchful waiting had a significantly increased risk of death from prostate cancer compared with patients who underwent prostatectomy," the authors write. Ten-year survival rates from prostate cancer were 83 percent for prostatectomy, 75 percent for radiotherapy, 72 percent for watchful waiting, 41 percent for hormone therapy and 71 percent for other treatment. "The increased mortality associated with radiotherapy and watchful waiting was primarily observed in patients younger than 70 years and in patients with poorly differentiated tumors," or tumors that have certain cellular characteristics and are more likely to spread aggressively.
"Until clinical trials provide conclusive evidence, physicians and patients should be informed of these results and their limitations," the authors conclude.
(Arch Intern Med. 2007;167(18):1944-1950. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported in part by a PROSPER (Program for Social Medicine, Preventive and Epidemiological Research) grant from the Swiss National Science Foundation. 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 8, 2007
Media Advisory: To contact corresponding author Sumit R. Majumdar, M.D., M.P.H., call Jo-Anne Nugent-Sexsmith at 780-492-9651.
HOSPITALIZED PATIENTS WITH PNEUMONIA WHO PREVIOUSLY RECEIVED PNEUMOCOCCAL VACCINE HAVE LOWER RATE OF DEATH OR ICU ADMISSION
CHICAGO—Among patients hospitalized with community-acquired pneumonia, those who had previously received the pneumococcal vaccine had a lower risk of death and admission to the intensive care unit than patients who were not vaccinated, according to a report in the Oct. 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Community-acquired pneumonia is a common condition resulting in considerable illness and death, according to background information in the article. A vaccine against Streptococcus pneumoniae, one of the causes of pneumonia—23-valent polysaccharide pneumococcal vaccine (PPV)—has been available since 1983. Most guidelines recommend PPV for those at high risk of developing pneumonia, including older adults and nursing home residents. However, some doubts have been raised about the effectiveness of PPV, and vaccination rates remain below the target 80 percent to 90 percent in these populations.
Jennie Johnstone, M.D., and colleagues at the University of Alberta, Edmonton, Canada, collected data on 3,415 patients with community-acquired pneumonia admitted to six hospitals between 2000 and 2002. The patients’ vaccination status was determined through interviews, medical record reviews, contact with primary care physicians and records from the regional office of community health.
Of the patients, 22 percent had been vaccinated with PPV, and 624 died or were admitted to the intensive care unit (ICU). Those who had been vaccinated with PPV were less likely to die or be admitted to the ICU than those who had not been vaccinated (10 percent vs. 21 percent). This finding was mostly a result of lower ICU admissions—less than 1 percent of those vaccinated were admitted to the ICU, compared with 13 percent of those who were not vaccinated. Results were similar when the researchers looked only at patients older than 65 or those living in nursing homes—groups for whom universal PPV vaccination is recommended.
"In addition to improved clinical outcomes, our results suggest that there may also be an associated reduction in costs associated with pneumococcal vaccination, a health economic benefit that has not been captured in previous cost-effectiveness analyses of this vaccine," the authors write. "Specifically, much of the benefit in our study was in terms of reduction in the need for costly ICU admissions; previous cost analyses have been restricted to examining the benefits of preventing pneumococcal disease but may have not adequately captured the possibility of attenuating the severity or mitigating the cost of disease in those for whom pneumonia is not prevented."
Although 2,416 of the patients were eligible for vaccination upon being discharged from the hospital, only 215 (9 percent) received PPV at this time. "We believe that our results further the emphasize the importance of adopting current adult pneumococcal vaccination guidelines, particularly since only 22 percent of our population were vaccinated before their hospitalization and less than 10 percent of eligible patients were vaccinated before hospital discharge," the authors conclude.
(Arch Intern Med. 2007;167(18):1938-1943. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by an establishment grant from Alberta Heritage Foundation for Medical Research (AHFMR); grants-in-aid from Capital Health; and unrestricted grants from Abbott Canada, Pfizer Canada, and Jannsen-Ortho Canda. Co-author Dr. Majumdar receives salary support awards from AHFMR and the Canadian Institutes of Health Research (CIHR). Co-author Mr. Eurich receives a doctoral studentship from 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 8, 2007
Media Advisory: To contact Walter A. Rocca, M.D., M.P.H., call Carol Lammers at 507-284-5037.
RELATIVES OF PATIENTS WITH PARKINSON’S DISEASE HAVE INCREASED RISK OF DEVELOPING DEMENTIA OR COGNITIVE IMPAIRMENT
CHICAGO—Relatives of patients with Parkinson’s disease may have an increased risk of developing dementia or cognitive impairment, according to a report in the October issue of Archives of Neurology, one of the JAMA/Archives journals.
Parkinson’s disease is characterized by a decline in the functions of the central nervous system, such as motor skills and speech. Several studies have shown an increased risk of dementia in first-degree relatives of Parkinson’s disease patients, while other studies have not confirmed the association, according to background information in the article. "The co-occurrence of Alzheimer’s disease and Parkinson’s disease in families and in individuals may be due to the sharing of susceptibility genetic variants," the authors write.
Walter A. Rocca, M.D., M.P.H, of the Mayo Clinic College of Medicine, Rochester, Minn., and colleagues studied 1,019 first-degree relatives of 162 patients with Parkinson’s disease, 858 relatives of 147 people who were the same age and sex as someone in the Parkinson’s disease group but did not have the condition and 2,716 relatives of 411 patients with Parkinson’s disease who were referred to the Mayo Clinic. Dementia and cognitive impairment were determined by responses to a telephone questionnaire or cognitive test and a review of participants’ medical records.
"This study provides evidence that relatives of patients with Parkinson’s disease have an increased risk of cognitive impairment or dementia. This association is primarily driven by families of patients with younger age at onset of Parkinson’s disease, but the risk does not vary across relatives of patients with different clinical characteristics of Parkinson’s disease," the authors write. Relatives of patients who experienced the onset of the disease at age 66 or younger had a particularly increased risk of developing dementia or cognitive impairment.
"The observed associations suggest the action of shared familial susceptibility factors, genetic or nongenetic," they conclude.
(Arch Neurol. 2007;64(10):1458-1464.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Institutes of Health and was made possible by a Rochester Epidemiology Project grant, also 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 8, 2007
Media Advisory: To contact corresponding author Eelco F.M. Wijdicks, M.D., Ph.D., call Carol Lammers at 507-284-5037.
CENTRAL NERVOUS SYSTEM INFECTIONS RARE BUT DEVASTATING FOLLOWING HEART TRANSPLANTATION
CHICAGO—Central nervous system infections develop infrequently following heart transplants but are a significant predictor of death, according to an article posted online today that will appear in the December 2007 print issue of Archives of Neurology, one of the JAMA/Archives journals.
In the past 10 years, approximately 24,000 Americans have undergone heart transplantation, according to background information in the article. Improvements in surgical techniques and immunosuppressive medications have resulted in increased survival rates for transplant recipients.
Diederik van de Beek, M.D., Ph.D., and colleagues at the Mayo Clinic College of Medicine, Rochester, studied 315 consecutive patients who underwent heart transplants there from January 1988 through June 2006. Data were gathered from the clinic databases, electronic and paper medical records, laboratory records and cranial imaging tests.
Eight patients (3 percent) developed central nervous system infections, all within four years after transplantation. The most common symptoms were confusion or headache (88 percent), often without the classic signs of fever and neck stiffness. Three of the eight patients died (38 percent), and two (25 percent) survived with mild complications.
Three patients developed cryptococcal meningitis, two had progressive multifocal leukoencephalopathy, two had varicella-zoster virus encephalitis, and one had Aspergillus fumigatus infection. "Varicella-zoster virus encephalitis has not been previously reported in heart transplant recipients, to our knowledge, but has been described in patients after bone marrow transplantation or in patients with HIV infection," the authors write. "Whether varicella-zoster virus encephalitis is emerging in other transplant populations should be a subject of further research."
Examining the cerebrospinal fluid did not necessarily help determine the cause of central nervous system infections, though protein levels were usually elevated in infected patients. "Nevertheless, appropriate management and rapid diagnosis can be achieved by taking a careful history and with physical examination, neuroimaging and diagnostic microbiological techniques," the authors write. "Because the mortality and morbidity rates are high, aggressive diagnosis and intervention are warranted in heart transplant recipients with suspected central nervous system infection."
(Arch Neurol. 2007;64(12):(doi:10.1001/archneur.64.12.noc70065).
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Dr. van de Beek is supported by the Meerwaldt Foundation, the Netherlands Organization for Health Research and Development (ZonMw) and a grant from NWO-Rubicon. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 8, 2007
Media Advisory: To contact corresponding author Paulus T.V.M. de Jong, M.D., Ph.D., e-mail: p.dejong{at}nin.knaw.nl.
ELEVATED LEVELS OF INFLAMMATORY MARKER MAY BE ASSOCIATED WITH INCREASED RISK OF AGE-RELATED EYE DISEASE
CHICAGO—High blood levels of C-reactive protein, a substance linked to inflammation, appear to be associated with an increased risk for age-related macular degeneration, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Age-related macular degeneration or aging macula disorder (AMD) occurs when the macula, the area at the back of the retina involved in sharp vision, deteriorates over time. Inflammation appears to play a role in the development of AMD, according to background information in the article. Proteins associated with inflammation, such as fibrinogen and C-reactive protein, have been found in drusen—the white deposits below the retina that are a hallmark of AMD.
Sharmila S. Boekhoorn, M.D., Ph.D., of the Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues examined C-reactive protein levels in 4,914 individuals at risk for AMD. At the initial examination, conducted between 1990 and 1993, blood samples were collected and photographs were taken of the retina. Three additional examinations were conducted over an average of 7.7 years.
During this time, 658 individuals were diagnosed with AMD, including 561 with early (initial stage) AMD and 97 with late (more advanced) AMD. As an individual’s C-reactive protein level increased above the median (midpoint) of the study population, he or she became more likely to develop AMD.
"Evidence is accumulating that inflammatory and immune-associated pathways have a role in other degenerative diseases associated with advancing age, such as atherosclerosis and Alzheimer’s disease," the authors write. "Drusen components have been found in atherosclerotic plaques and deposits in Alzheimer’s disease, and AMD, atherosclerosis, and Alzheimer’s disease may partly share a similar inflammatory pathogenesis."
Based on these results, reducing C-reactive protein levels could potentially decrease risk for AMD, the authors note. "A substance that can selectively inhibit C-reactive protein synthesis has not yet been developed, to our knowledge," they write. "Smoking and high body mass index increase C-reactive protein levels. Moderate alcohol intake, diets with a low glycemic index and statin and multivitamin use reduce C-reactive protein levels." Smoking and obesity are already known to increase risk for AMD.
(Arch Ophthalmol. 2007;125(10):1396-1401. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Netherlands Organization for Scientific Research and by the following foundations: Optimix, Physico Therapeutic Institute, Blindenpenning, Sint Laurens Institute, Bevordering van Volkskracht, Blindenhulp, Rotterdamse Blindenbelangen Association, OOG, kfHein, Prins Bernhard Cultuurfonds, Van Leeuwen Van Lignac, Verhagen and Elisa Mathilde. An unrestricted grant was obtained from Topcon Europe BV. 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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