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 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, February 27, 2007)
JAMA NEWS RELEASES
HPV INFECTION COMMON AMONG FEMALES IN U.S.
CERTAIN COGNITIVE BEHAVIORAL THERAPY APPEARS BENEFICIAL FOR FEMALE VETERANS WITH POSTTRAUMATIC STRESS DISORDER
DELAYS AND LACK OF COMMUNICATION TO PRIMARY CARE PHYSICIANS COMMON AFTER HOSPITAL DISCHARGE
USE OF SOME ANTIOXIDANT SUPPLEMENTS MAY INCREASE MORTALITY RISK
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
APPROXIMATELY ONE IN FOUR AMERICAN WOMEN HAVE HPV INFECTION - ALMOST HALF OF WOMEN AGES 20-24
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This week's JAMA Report video is on the prevalence of HPV infection. The report will be fed Tuesday, February 27, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (C-Band), Transponder 09, Downlink Frequency 3880 MHz Vertical, Audio: 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 27, 2007
Media Advisory: To contact Eileen F. Dunne, M.D., M.P.H., call Tammy Nunnally at 404-639-8895. To contact editorialist Susan C. Weller, Ph.D., call Thomas Curtis at 409-772-2455.
HPV INFECTION COMMON AMONG FEMALES IN U.S.
CHICAGO—Data from a national study suggests that about one in four U.S. females between the ages of 14 and 59 years may have the sexually transmitted infection human papillomarivus (HPV), according to a study in the February 28 issue of JAMA.
Human papillomavirus is estimated to be the most common sexually transmitted infection in the United States. However, there have been no data on the prevalence of HPV among women across a broad age range and representative of the U.S. population. High-risk HPV types can cause cervical, anal, and other genital cancers. High-risk HPV types are detected in 99 percent of cervical cancers, and worldwide approximately 70 percent of cervical cancers are due to HPV types 16 and 18, according to background information in the article. A highly effective vaccine against HPV types 6, 11, 16, and 18 was licensed in June 2006 and recommended for routine use in females age 11 to 12 years in the United States. Data on type-specific prevalence of HPV in the United States could help measure the effectiveness of the vaccine for reducing infection and could help evaluate its impact and cost effectiveness.
Eileen F. Dunne, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues estimated the prevaccine prevalence of HPV in the U.S. by performing HPV DNA testing on 2,026 self-collected vaginal swabs among females age 14 to 59 years participating in the National Health and Nutrition Examination Survey (NHANES) 2003-2004.
Of the 1,921 adequate specimens, 26.8 percent were positive for any HPV DNA. Using 2000 Census data and extrapolating this prevalence rate to the population, the authors estimate that approximately 24.9 million females in this age range have prevalent HPV infection. Prevalence of any HPV infection was highest among females age 20 to 24 years (44.8 percent); overall HPV prevalence among females age 14 to 24 years was 33.8 percent. This prevalence corresponds with 7.5 million females with HPV infection, which is higher than the previous estimate of 4.6 million HPV infections among females in this same age group in the United States.
There was a significant trend for increasing HPV prevalence with each year of age from 14 to 24 years, followed by a gradual decline in HPV prevalence through 59 years. Independent risk factors for HPV detection were age, marital status and increasing numbers of lifetime and recent sex partners.
Overall, HPV types 6, 11, 16, or 18 were detected in 3.4 percent of the study participants, corresponding with 3.1 million females with prevalent infection with HPV types included in the quadrivalent HPV vaccine.
“Our study provides the first national estimate of prevalent HPV infection among females aged 14 to 59 years in the United States,” the authors write. “Our data indicate that the burden of prevalent HPV infection among women was higher than previous estimates. However, the prevalence of HPV vaccine types was relatively low.”
(JAMA. 2007;297:813-819. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Division of STD Prevention, 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.
EDITORIAL: ESTIMATING THE POPULATION PREVALENCE OF HPV
Susan C. Weller, Ph.D., and Lawrence R. Stanberry, M.D., Ph.D., of the University of Texas Medical Branch, Galveston, comment on the findings of Dunne and colleagues.
“The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices has provisionally recommended the HPV vaccine for adolescent girls between the ages of 11 and 12 years with catch-up vaccination for those between 13 and 26 years. More information is needed about the prevalence of HPV-16/18 in women older than 26 years to help determine whether women in this age group would benefit from immunization. Follow-up prevalence studies will be important not only to evaluate vaccine effectiveness but also to address the question of whether other high-risk oncogenic [causing tumors] HPV types will fill the ecological niche created by the expected decline in HPV-16 and HPV-18. Studies of cost-effectiveness of the vaccine have used HPV prevalence estimates from selected populations, including some outside the United States. Now it will be important to assess the cost-effectiveness of the vaccine using these new prevalence data from U.S. females.”
(JAMA. 2007;297:876-878. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – none reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 27, 2007
Media Advisory: To contact Paula P. Schnurr, Ph.D., call Peggy Willoughby at 802-296-5132.
CERTAIN COGNITIVE BEHAVIORAL THERAPY APPEARS BENEFICIAL FOR FEMALE VETERANS WITH POSTTRAUMATIC STRESS DISORDER
CHICAGO—Using a cognitive behavioral therapy called “prolonged exposure” appears more effective than “present-centered” therapy, a supportive intervention to treat female military veterans and active duty women with posttraumatic stress disorder, according to a study in the February 28 issue of JAMA.
“Events such as the terrorist attacks on September 11, 2001, the war in Iraq, and hurricane Katrina have focused attention on posttraumatic stress disorder (PTSD), an anxiety disorder that can result from exposure to traumatic events like combat, rape, assault, and disaster. Posttraumatic stress disorder is characterized by symptoms of re-experiencing the traumatic event, avoiding reminders of the event or feeling emotionally numb, and a state of increased psychological and physiological tension. The disorder is associated with psychiatric and physical illnesses, reduced quality of life, and substantial economic costs to society”, according to background information in the article. “Lifetime prevalence in U.S. adults is higher in women (9.7 percent) than in men (3.6 percent) and is especially high among women who have served in the military.” There has been no prior study to evaluate treatment for PTSD in this group.
Paula P. Schnurr, Ph.D., of the National Center for PTSD, White River Junction, Vt., and colleagues conducted a study to compare the effectiveness of two types of treatments for PTSD, prolonged exposure and present-centered therapy. Prolonged exposure is a cognitive behavioral therapy (CBT) in which a patient is asked to vividly recount a traumatic event repeatedly until the patient’s emotional response decreases and to gradually confront safe but fear-evoking trauma reminders. Present-centered therapy, a supportive intervention which is typically used by Department of Veterans Affairs (VA) clinicians to address the problems of female veterans with PTSD, includes discussing and reviewing general daily difficulties that may be manifestations of PTSD.
The randomized controlled trial included female veterans (n = 277) and active-duty personnel (n = 7) with PTSD who were recruited from nine VA medical centers, two VA readjustment counseling centers, and one military hospital, from August 2002 through October 2005. Participants were randomly assigned to receive prolonged exposure (n = 141) or present-centered therapy (n = 143), delivered in 10 weekly 90-minute sessions. PTSD symptom severity data were collected before and after treatment and at 3- and 6-month follow-up.
The researchers found that women who received the prolonged exposure therapy were more likely than women who received the present-centered therapy to no longer meet criteria for the diagnosis of PTSD (41.0 percent vs. 27.8 percent) and were more than twice as likely to achieve total remission (15.2 percent vs. 6.9 percent). Self-reported PTSD, depression, and overall mental health improved from pretreatment to post-treatment in both groups. Anxiety decreased and quality of life improved with prolonged exposure.
“Practice guidelines for PTSD recommend prolonged exposure and other CBT, but the treatments are not widely used. Along with recent findings, our study demonstrates the feasibility of implementing CBT across a range of clinical settings. With the high prevalence of PTSD among military personnel returning from service in Iraq and Afghanistan, the challenge for large health care systems like those of the VA and the Department of Defense is to find efficient ways to train personnel to promote dissemination of these effective treatments,” the authors conclude.
(JAMA. 2007;297:820-830. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was conducted with support from the VA Cooperative Studies Program and the Department of Defense. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 27, 2007
Media Advisory: To contact Sunil Kripalani, M.D., M.Sc., call Kathi Baker at 404-727-9371.
DELAYS AND LACK OF COMMUNICATION TO PRIMARY CARE PHYSICIANS COMMON AFTER HOSPITAL DISCHARGE
CHICAGO—Primary care physicians often do not receive adequate patient information from the hospital-based physician following discharge, according to a review article in the February 28 issue of JAMA.
According to background information in the article, “As the specialty of hospital medicine expands, the transfer of responsibility for patient care between hospital-based physicians and primary care physicians becomes increasingly common, creating a need to improve communication and information transfer between inpatient and outpatient physicians at hospital discharge. Timely transfer of accurate, relevant data about diagnostic findings, treatment, complications, consultations, tests pending at discharge, and arrangements for postdischarge follow-up” is important. “Delayed communication or inaccuracies in information transfer among health care professionals, particularly during the early postdischarge period, could have substantial implications for continuity of care, patient safety and patient and clinician satisfaction.” The extent to which physicians successfully transfer timely and accurate patient information at hospital discharge is uncertain.
Sunil Kripalani, M.D., M.Sc., of the Emory University School of Medicine, Atlanta, and colleagues performed a review of medical literature to characterize the types and prevalence of deficits in communication and information transfer between hospital-based physicians and primary care physicians at hospital discharge. The researchers analyzed 55 observational studies investigating communication and information transfer at hospital discharge and 18 controlled studies evaluating the efficacy of interventions to improve information transfer.
The researchers found that direct communication between hospital physicians and primary care physicians during the discharge process occurred infrequently. Only 3 percent of primary care physicians reported being involved in discussions about discharge, and 17 percent to 20 percent reported always being notified about discharges.
“The availability of a discharge summary at the first postdischarge visit was low (12 percent - 34 percent) and remained poor at 4 weeks (51 percent - 77 percent), affecting the quality of care in approximately 25 percent of follow-up visits and contributing to primary care physician dissatisfaction. Discharge summaries often lacked important information such as diagnostic test results (missing from 33 percent - 63 percent), treatment or hospital course (7 percent - 22 percent), discharge medications (2 percent - 40 percent), tests results pending at discharge (65 percent), patient or family counseling (90 percent - 92 percent), and follow-up plans (2 percent - 43 percent),” the researchers write.
“Several interventions, including computer-generated discharge summaries and using patients as couriers shortened the delivery time of discharge communications. Use of standardized formats to highlight the most pertinent information improved the perceived quality of documents.”
“Deficits in communication and information transfer between hospital-based physicians and primary care physicians are substantial and ubiquitous. The traditional methods of completing and delivering discharge summaries are suboptimal for communicating timely, accurate, and medically important patient data to the physicians who will be responsible for follow-up care. Urgent improvements are needed in the processes and formats used for transferring information to primary care physicians at hospital discharge,” the authors write.
“A number of interventions appear effective in improving the timeliness and perhaps quality of discharge summaries, and application of health information technology bears particular promise. The baton of responsibility for patient care must be passed with confidence and certainty while ensuring that important information is not dropped during patient transitions from acute hospital care to the community,” the researchers conclude.
(JAMA. 2007;297:831-841. Available to the media 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 27, 2007
Media Advisory: To contact Goran Bjelakovic, M.D., Dr.Med.Sci., email: goranb{at}junis.ni.ac.yu.
USE OF SOME ANTIOXIDANT SUPPLEMENTS MAY INCREASE MORTALITY RISK
CHICAGO—Contradicting claims of disease prevention, an analysis of previous studies indicates that the antioxidant supplements beta carotene, vitamin A, and vitamin E may increase the risk of death, according to a meta-analysis and review article in the February 28 issue of JAMA.
Many people take antioxidant supplements, believing they improve their health and prevent diseases. Whether these supplements are beneficial or harmful is uncertain, according to background information in the article.
Goran Bjelakovic, M.D., Dr.Med.Sci., of the Center for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark, and colleagues conducted an analysis of previous studies to examine the effects of antioxidant supplements (beta carotene, vitamins A and E, vitamin C [ascorbic acid], and selenium) on all-cause death of adults included in primary and secondary prevention trials. Using electronic databases and bibliographies, the researchers identified and included 68 randomized trials with 232,606 participants in the review and meta-analysis. The authors also classified the trials according to the risk of bias based on the quality of the methods used in the study, and stratified trials as “low-bias risk” (high quality) or “high-bias risk” (low quality).
In an analysis that pooled all low-bias risk and high bias risk trials, there was no significant association between antioxidant use and mortality. In 47 low-bias trials involving 180,938 participants, the antioxidant supplements were associated with a 5 percent increased risk of mortality. Among low-bias trials, use of beta carotene, vitamin A, and vitamin E was associated with 7 percent, 16 percent and 4 percent, respectively, increased risk of mortality, whereas there was no increased mortality risk associated with vitamin C or selenium use.
“Our systematic review contains a number of findings. Beta carotene, vitamin A, and vitamin E given singly or combined with other antioxidant supplements significantly increase mortality. There is no evidence that vitamin C may increase longevity. We lack evidence to refute a potential negative effect of vitamin C on survival. Selenium tended to reduce mortality, but we need more research on this question,” the authors write.
“Our findings contradict the findings of observational studies, claiming that antioxidants improve health. Considering that 10 percent to 20 percent of the adult population (80-160 million people) in North America and Europe may consume the assessed supplements, the public health consequences may be substantial. We are exposed to intense marketing with a contrary statement, which is also reflected by the high number of publications per included randomized trial found in the present review.”
“There are several possible explanations for the negative effect of antioxidant supplements on mortality. Although oxidative stress has a hypothesized role in the pathogenesis of many chronic diseases, it may be the consequence of pathological conditions. By eliminating free radicals from our organism, we interfere with some essential defensive mechanisms … Antioxidant supplements are synthetic and not subjected to the same rigorous toxicity studies as other pharmaceutical agents. Better understanding of mechanisms and actions of antioxidants in relation to a potential disease is needed,” the researchers conclude.
(JAMA. 2007;297:842-857. Available to the media at www.jamamedia.org)
Editor's Note: Supported by The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
APPROXIMATELY ONE IN FOUR AMERICAN WOMEN HAVE HPV INFECTION – ALMOST HALF OF WOMEN AGES 20-24
INTRO:
A new vaccine has been recommended to help prevent infection with human papillomavirus, or HPV, and certain strains of HPV that can sometimes lead to cervical cancer. In a new study that measured how many American women have HPV, researchers discovered that approximately one in four women have HPV infection. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
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Dr. Horowitz in exam room talking to nurse
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“Just move the scope a little bit before we bring the patient in.”
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Dr. Horowitz with scope talking to nurse
AUDIO:
DR. IRA HOROWITZ SEES ALL SORTS OF PATIENTS WHO HAVE HUMAN PAPILLOMAVIRUS, OR HPV, INFECTIONS.
VIDEO:
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Super: Ira Horowitz, M.D.
Emory Univ. School of Medicine
Runs :11
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“I see teenagers who have had intercourse with just one person, all the way to women in their 80s who have been exposed to the virus and now have manifestations as abnormal pap smears and pre-cancerous lesions.”
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B-ROLL
Bite video runs to “new”
GFX/JAMA Cover
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SO HE’S NOT SURPRISED BY THE FINDINGS OF A NEW STUDY PUBLISHED IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
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Super: Eileen Dunne, M.D., M.P.H.
Centers for Disease Control and Prevention
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“We found that overall HPV prevalence among females in the United States, ages 14 to 59 years of age, was 26.8%, and that means one in four women are infected with HPV.”
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Dr. Dunne and colleague looking over data
Crowd shot (no faces showing)
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DR. EILEEN DUNNE WAS PART OF THE STUDY FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION. SHE USED HEALTH DATA FROM MORE THAN TWO-THOUSAND WOMEN AGES 14 TO 59, TO ESTIMATE NATIONAL HPV INFECTION RATES.
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Eileen Dunne, M.D., M.P.H.
Centers for Disease Control and Prevention
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“The prevalence was highest among the 20 to 24-year old women. Almost half of those women were infected with HPV.”
VIDEO:
B-ROLL
Video from National Cancer Institute of young woman having gynecologic exam and lab technician pulling vaccine into syringe
AUDIO:
THERE ARE HUNDREDS OF KINDS OF HPV INFECTIONS. SOME CAN LEAD TO CANCER. THE NEW VACCINE COVERS TWO HPV TYPES THAT CAUSE MOST CERVICAL CANCER, AND TWO TYPES THAT CAUSE GENITAL WARTS.
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Eileen Dunne, M.D., M.P.H.
Centers for Disease Control and Prevention
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AUDIO:
“3.4 % of women had infection with the types of HPV that could be prevented by the HPV vaccine.”
VIDEO:
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Syringe with vaccine
Gynecologist doing cervical exam on young woman
AUDIO:
BUT EVEN WITH THE VACCINE, CERVICAL CANCER SCREENING IS IMPORTANT…
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Eileen Dunne, M.D., M.P.H.
Centers for Disease Control and Prevention
Runs :10
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“Because 70% of cervical cancers are prevented by the HPV vaccine, but there’s a remaining 30% that are not prevented by this vaccine.”
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Dr. Horowitz with nurse as she sets up exam tray
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DR. HOROWITZ AGREES, AND SAYS THERE ARE THREE WAYS TO PREVENT HPV INFECTION.
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Ira Horowitz, M.D.
Emory Univ. School of Medicine
Runs :10
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“One, abstinence, the second, using condoms or barrier methods, which is not 100% effective, and the third being the papillomavirus vaccine.” ”
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Dr. Dunne
Dr. Horowitz and nurse walking down hall, knocking on exam door and entering
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BOTH DOCTORS HOPE TO SEE FEWER HPV INFECTIONS IN THE FUTURE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. Dunne says the number of HPV-infected women is likely even higher than the study showed. That’s because the study only measured active infections. For more information, visit www.jama.com. Please see the complete study for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
