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 Early Release: 10:00 a.m. ET, Tuesday, June 26, 2007)
JAMA NEWS RELEASES
WEIGHT MANAGEMENT PROGRAM IMPROVES BODY FAT LEVELS, DIABETES RISK FACTORS FOR OVERWEIGHT CHILDREN
AMONG YOUTH IN U.S., WHITES HAVE HIGHEST INCIDENCE OF DIABETES
CHILDHOOD CANCER SURVIVORS AT INCREASED RISK OF SEVERE HEALTH PROBLEMS AS ADULTS
PLACE OF DEATH SHIFTING FOR CHILDREN WITH COMPLEX CHRONIC CONDITIONS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
WHITE CHILDREN MOST LIKELY TO HAVE TYPE 1 DIABETES, MINORITY TEENS MOST LIKELY TO HAVE TYPE 2 DIABETES
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the incidence of diabetes in youth in the U.S. The report will be fed Tuesday, June 26, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 09, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Early Release: 10:00 a.m. ET, Tuesday, June 26, 2007
Media Advisory: To contact Mary Savoye, R.D., CD.-N., C.D.E., call Karen Peart at 203-432-1326.
WEIGHT MANAGEMENT PROGRAM IMPROVES BODY FAT LEVELS, DIABETES RISK FACTORS FOR OVERWEIGHT CHILDREN
NEW YORK—Children who participated in a family-based weight management program designed for inner-city minority children had better outcomes regarding weight gain, body fat, body mass index (BMI) and insulin sensitivity compared to children who received traditional weight counseling in a clinic, according to a study in the June 27 issue of JAMA, a theme issue on chronic diseases of children.
Mary Savoye, R.D., CD.-N., C.D.E., of Yale University, New Haven, Conn., presented the findings of the study at a JAMA media briefing in New York.
The percentage of children and adolescents in the U.S. who are overweight has increased significantly in recent years, up to 17 percent in 2004, and with an even higher prevalence among African American and Hispanic youth (18 percent - 26 percent). The epidemic of childhood obesity has been accompanied by an increase of type 2 diabetes among adolescents, and is more common in African American and Hispanic youth. "Since an overweight child has a high probability of becoming an overweight adult, the grave concerns for the long-term health of obese children are well justified," the authors write. Few studies have reported successful weight control interventions in children and adolescents.
This one-year randomized clinical trial, conducted May 2002 - September 2005, evaluated the effectiveness of a weight management program, Bright Bodies, in comparison to routine care provided at a pediatric obesity clinic. This weight management program is a family-based, intensive lifestyle intervention that has been specially tailored for the needs of inner-city minority children. The primary aim of the study was to compare changes in BMI, body composition, insulin sensitivity, blood pressure, and lipid profiles.
The study included 209 overweight children (BMI greater than the 95th percentile for age and sex), ages 8 to 16 years of mixed ethnic groups. A total of 135 participants (60 percent) completed six months of the study, 119 (53 percent) completed 12 months. Participants were randomly assigned to either a control or weight management group. The control group (n = 69) received traditional clinical weight management counseling every six months, and the weight management group (n = 105) received an intensive family-based program including exercise, nutrition education and behavior modification. Intervention occurred bi-weekly the first six months and bi-monthly thereafter to mimic a "maintenance phase" of the program.
The researchers found that while average body weight was essentially unchanged from baseline after 12 months in the weight management group (+.67 lbs.), BMI change was −1.7. In contrast, the control group gained 16.94 pounds and increased their BMI by 1.6 units. Percent and total body fat were reduced in the weight management group, and increased in the control group. The difference between the two groups in changes in BMI (−3.3), body weight (−16.3 lbs.), body fat (−20.3 lbs.), and percent body fat (−6.0 percent) after 12 months were significantly different. Total cholesterol improved in the weight management group, but not in the control group.
The difference between the two groups in insulin sensitivity, a parameter that measures the risk of the development of type 2 diabetes, was also significantly different at 12 months. The weight management group had an increase in insulin sensitivity, which is associated with a decreased risk of the development of type 2 diabetes.
"As illustrated by the outcomes in the control group in this study, simple education about health risks of obesity and routine counseling regarding diet and exercise are insufficient to prevent the seemingly inexorable increases in BMI, body weight, and body fat observed in traditionally treated overweight children," the authors write. "In contrast to conventional wisdom regarding the futility of changing the lifestyle of overweight children, we have shown that a family-based program that uses nutrition education, behavior modification, and supervised exercise can lower BMI, improve body composition, and increase insulin sensitivity."
"The success of the Bright Bodies program undoubtedly relates, in part, to the frequent contacts between families and the professional staff. While the program was very successful in treating overweight children, the expense incurred in operating such a program is substantial. Future work for our group includes cost-benefit analyses, as this would be helpful for pediatric clinicians or health management organizations that are considering offering similar services to overweight children and adolescents."
(JAMA. 2007;297:2697-2704. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by NIH grants to General Clinical Research Center and co-author Sonia Caprio, M.D., Yale University School of Medicine, and an unrestricted gift from the McPhee Foundation, Bristol, Conn. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, 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 Early Release: 10:00 a.m. ET, Tuesday, June 26, 2007
Media Advisory: To contact Dana Dabelea, M.D., Ph.D., call Caitlin Jenney at 303-724-1523. To contact editorial author Rebecca B. Lipton, Ph.D., M.P.H., B.S.N., call Theresa Carson at 773-702-6241.
AMONG YOUTH IN U.S., WHITES HAVE HIGHEST INCIDENCE OF DIABETES
NEW YORK—Non-Hispanic white youth have the highest rate of diabetes of all racial/ethnic groups for children in the U.S., with type 1 being the predominant kind of diabetes among youth, according to a study in the June 27 issue of JAMA, a theme issue on chronic diseases of children.
Dana Dabelea, M.D., Ph.D., of the University of Colorado Health Sciences Center, Denver, presented the findings of the study at a JAMA media briefing in New York.
Estimates of the incidence of type 1 diabetes mellitus (DM) show an increase in incidence worldwide during the past two decades, according to background information in the article. Type 2 DM has traditionally been viewed as a disorder of adults, most likely persons who are middle-age or elderly. But as the prevalence of obesity has increased in recent decades, some studies have reported an increasing proportion of youth with type 2 DM, especially among racial/ethnic minority populations. However, data are limited regarding the types and incidence of DM among U.S. youth of different racial/ethnic backgrounds.
Dr. Dabelea and colleagues with the SEARCH for Diabetes in Youth Study Group identified the cases of DM among individuals younger than 20 years in the U.S. to estimate the population incidence of type 1 and 2 DM overall and by age and race/ethnicity. The study included 2,435 multi-ethnic youth with newly diagnosed DM in 2002 and 2003, from 10 locations in the U.S.
Overall, the incidence rate (per 100,000 person-years [the number of individuals in the study times the number of years of follow-up per person]) of DM was 24.3. The incidence rate was highest among 10- to 14-year-old youth (33.9), and slightly higher in females vs. males. Overall, the highest incidence rates of DM were observed among non-Hispanic white (26.1), African American (25.4), and American Indian youth (25.0), with lower rates among Hispanic and Asian-Pacific Islander youth.
For children age 0 to 4 years and 5 to 9 years, most DM was type 1, regardless of race/ethnicity. The incidence of type 1 DM was highest among non-Hispanic white children, and lowest among American Indian and Asian-Pacific Islander children. Similarly, for older youth (10-14 years and 15-19 years), the incidence of type 1 DM was highest among non-Hispanic white children, followed by African American and Hispanic youth.
"...taken together [with other studies], these data suggest that the incidence of type 1 DM may be increasing in the United States, consistent with worldwide trends," the authors write. "We estimate that the annual number of newly diagnosed youth with type 1 DM in the United States is approximately 15,000."
Overall, type 2 DM was relatively infrequent, but the highest rates were documented among 15- to 19-year-old minority groups, including American Indian youth, followed by African American, Asian-Pacific Islander, and Hispanic youth. "Although the evidence of the presence of type 2 DM in youth is still developing, it is consistent with the increasing prevalence of type 2 DM in adults, and the increasing prevalence of obesity in both adults and children."
"The SEARCH study provides unique population-based data on the incidence of DM among youth of various racial/ethnic backgrounds, according to DM type. Continuing this surveillance effort will document temporal trends in the incidence of DM among various racial/ethnic groups and accurately assess the future health care burden of DM and its complications in the U.S. pediatric and young adult population," the researchers conclude.
(JAMA. 2007;297:2716-2724. Available pre-embargo 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.
EDITORIAL: INCIDENCE OF DIABETES IN CHILDREN AND YOUTH — TRACKING A MOVING TARGET
In an accompanying editorial, Rebecca B. Lipton, Ph.D., M.P.H., B.S.N., of the University of Chicago, comments on the findings of Dabelea and colleagues.
"The SEARCH project adds some detail to the understanding of the changing nature of diabetes risk in the United States. The authors have ascertained cases in a range of settings, under the stringent privacy regulations that have constrained much population-based research in the United States recently. In particular, their group is well positioned to examine geographic differences in diabetes risk among the diverse locations represented in the SEARCH study."
"As this and other research goes forward, it may be possible to develop a better understanding of the interplay of autoimmunity with youth-onset diabetes. There is an urgent need to go beyond studies such as this one by implementing a coordinated approach to childhood diabetes surveillance (i.e., mandated case-reporting). Only then can society respond effectively to the serious and increasing challenge of diabetes in youth."
(JAMA. 2007;297:2760-2761. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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 Early Release: 10:00 a.m. ET, Tuesday, June 26, 2007
Media Advisory: To contact Huib N. Caron, M.D., Ph.D., email: h.n.caron@amc.uva.nl. To contact editorial co-author Kevin C. Oeffinger, M.D., call Joanne Nicholas at 212-639-3137.
CHILDHOOD CANCER SURVIVORS AT INCREASED RISK OF SEVERE HEALTH PROBLEMS AS ADULTS
NEW YORK—A substantial proportion of childhood cancer survivors experience serious health problems as young adults, particularly those who received radiation treatment, according to a study in the June 27 issue of JAMA, a theme issue on chronic diseases of children.
Huib N. Caron, M.D., Ph.D., of Emma Children's Hospital/Academic Medical Center, Amsterdam, presented the findings of the study at a JAMA media briefing in New York.
The introduction of more effective treatments for childhood cancer has dramatically improved survival rates, but this has been accompanied by the occurrence of late, treatment-related complications such as second cancers, organ dysfunction, and psychosocial and cognitive problems. Information is limited on the occurrence and risk of subsequent illnesses among adults who had cancer as children, according to background information in the article.
Dr. Caron and colleagues conducted a study to assess the total burden of adverse health outcomes (adverse events) following childhood cancer and evaluated treatment-related risk factors. The study included 1,362 five-year survivors of childhood cancer treated in a single institution in the Netherlands between 1966 and 1996. All survivors were invited to a clinic for medical assessment of adverse events. Medical follow-up was completed for 94.3 percent of survivors (median [midpoint] follow-up, 17.0 years). At the end of follow-up the median age of the survivors was 24.4 years, with 88 percent of survivors younger than 35 years.
The researchers found that of the 1,362 survivors, 19.8 percent had no adverse events, 74.5 percent had one or more events and 24.6 percent had five or more events. Additionally, 36.8 percent of the survivors had at least one severe or life-threatening or disabling disorder, and 3.2 percent died due to an adverse event. Almost 22 percent of adverse events were severe, life-threatening or disabling, or caused death. Of those events, orthopedic disorders occurred most often, followed by second tumors, obesity, fertility disorders, psychosocial or cognitive disorders, neurologic disorders and endocrine disorders.
Of all patients treated with radiotherapy only, 55 percent had a high or severe burden of events (defined as at least two severe events or one or more life-threatening or disabling event), compared with 15 percent of patients treated with chemotherapy only and 25 percent of patients who had surgery only. Survivors of bone tumors most often had a high or severe burden of events (64 percent), while survivors of leukemia or Wilms tumor (tumor of the kidney) least often had a high or severe burden of events (12 percent each).
"In conclusion, childhood cancer survivors are at increased risk of many severe health problems, resulting in a high burden of disease during young adulthood. This will inevitably affect the survivors' quality of life and also will ultimately reduce their life expectancy. Therefore, we feel that risk-stratified lifelong medical surveillance of childhood cancer survivors is needed to allow early detection of adverse events that are amenable to intervention. Future studies should focus on the efficacy of follow-up programs and other intervention strategies for adverse events, to further improve health outcomes in survivors of childhood cancer," the authors write.
(JAMA. 2007;297:2705-2715. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Foundation of Paediatric Cancer Research, Amsterdam. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.
EDITORIAL: CHILDHOOD CANCER SURVIVORS, LATE EFFECTS, AND A NEW MODEL FOR UNDERSTANDING SURVIVORSHIP
In an accompanying editorial, Kevin C. Oeffinger, M.D., of Memorial Sloan-Kettering Cancer Center, New York, and Leslie L. Robison, Ph.D., of St. Jude Children's Research Hospital, Memphis, Tenn., write that it is important for physicians to understand the possible subsequent health problems for childhood cancer survivors.
"...most primary care physicians, as well as surgeons, obstetricians, cardiologists, and other specialists, are not familiar with the health risks of this relatively heterogeneous population. Hence, as these survivors enter their young and mid-adult years, a period when their risk for many serious late effects is at its highest, they might not be screened for various late effects that may be modifiable or amenable to early diagnosis and treatment."
"It is critically important for physicians to recognize these risks, facilitate risk-based health care, and strive to improve therapy that not only improves cure rates but also reduces long-term morbidity."
(JAMA. 2007;297:2762-2764. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Drs. Oeffinger and Robison report receiving grants from the National Institutes of Health.
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 Early Release: 10:00 a.m. ET, Tuesday, June 26, 2007
Media Advisory: To contact Chris Feudtner, M.D., Ph.D., M.P.H., call Rachel Salis-Silverman at 267-426-6063.
PLACE OF DEATH SHIFTING FOR CHILDREN WITH COMPLEX CHRONIC CONDITIONS
NEW YORK—It is becoming more common for children with complex chronic conditions to die in their home than in a hospital, although black and Hispanic children with these conditions are less likely to die in their home, according to a study in the June 27 issue of JAMA, a theme issue on chronic diseases of children.
Chris Feudtner, M.D., Ph.D., M.P.H., of Children's Hospital of Philadelphia, presented the findings of the study at a JAMA media briefing in New York.
Many pediatric palliative care clinicians suggest that the preferred place of death, by the family, of an infant, child, or adolescent with a medically complex chronic condition is the home. Advances in home-based medical technology and changes in attitudes about pediatric palliative care and hospice services may be making this a more viable option, according to background information in the article.
Dr. Feudtner and colleagues conducted a study to determine if the proportion of complex chronic condition-related deaths occurring at home among children and adolescents increased between 1989 and 2003, and to assess if there were any race and ethnicity disparities in the location of death. The researchers analyzed data from the National Center for Health Statistics' Multiple Cause of Death Files.
Among the 22.1 percent of deaths (198,160 of 896,509 total deaths) attributed to a complex chronic condition between 1989 and 2003, the percentage of deaths occurring at home increased significantly for all age groups (overall, from 10.1 percent in 1989 to 18.2 percent in 2003), but with larger increases for deaths beyond infancy. The odds of death occurring at home increased by 3.8 percent annually.
The percentage of individuals dying at home increased significantly over time for infants (4.9 percent home deaths in 1989 to 7.3 percent in 2003); 1 to 9-year-olds (17.9 percent to 30.7 percent), and 10 to 19-year-olds (18.4 percent to 32.2 percent). During this same period, there was a significant decline in the percentage of deaths occurring in the hospital for each of these three age categories.
The authors suggest that this gradual change in place of death may be occurring because of advances in medical technology in the home setting and broad shifts in attitudes and decision-making processes regarding palliative and end-of-life care in U.S. culture.
The child's race, ethnicity, and region of home residence were significantly associated with death occurring at home. The odds of dying at home were reduced by 50 percent among black individuals, and reduced by 48 percent among Hispanic individuals, when compared with whites.
Concerning possible reasons for the observed racial and ethnic differences, "...differential access to health care services or medical technology, divergent cultural attitudes or approaches to palliative and end-of-life care decision making, or differing levels of financial or other support within the patient's or family's social network may make dying at home more or less likely."
"...as efforts to improve understanding of the sources and remedies of racial and ethnic disparities in pediatric end-of-life care are completed, medical and other concerned professionals need to ensure that all patients have access to necessary care and that all dialogue and interactions regarding decisions about care—whether curative, life-extending, or palliative—are built on mutual understanding, trust, and respect," the authors conclude.
(JAMA. 2007;297:2725-2732. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: The conduct of this study was supported in part by grants from the Agency for Healthcare Research and Quality and the National Institute of Nursing Research of the National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, 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
WHITE CHILDREN MOST LIKELY TO HAVE TYPE 1 DIABETES, MINORITY TEENS MOST LIKELY TO HAVE TYPE 2 DIABETES
INTRO:
We hear a lot about diabetes in kids these days. So just how common is it and who is most likely to have it? A new study found that white children are the most likely to have type 1 diabetes, while minority teens are the most likely to have type 2 diabetes. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Nurse preparing to draw blood from Sierra’s arm
AUDIO:
ALMOST THREE YEARS AGO THIRTEEN-YEAR OLD SIERRA HORECKY WAS DIAGNOSED WITH TYPE ONE DIABETES. THAT MEANS HER BODY CAN’T MAKE THE HORMONE, INSULIN.
VIDEO:
SOT/FULL
@ :11
Super: Sierra Horecky
Has type 1 diabetes
Runs :04
AUDIO:
“At my school there’s only two kids with diabetes and I’m one of them.”
VIDEO:
B-roll
More Sierra having blood drawn
FULL SCREEN GRAPHIC
New cases each year
Type 1 diabetes – about 15,000 youth under age 19
Type 2 diabetes – about 3,700 youth under age 19
GFX/JAMA COVER
Male doctor talking with Hispanic mom and kids in exam room
AUDIO:
BUT THERE ARE THOUSANDS OF KIDS LIKE SIERRA. IN FACT, EACH YEAR IN THE U.S., ABOUT 15-THOUSAND KIDS ARE DIAGNOSED WITH TYPE ONE DIABETES, AND ABOUT 37-HUNDRED ARE DIAGNOSED WITH TYPE TWO, ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. THE STUDY IS PART OF A JAMA THEME ISSUE DEVOTED TO CHRONIC DISEASES IN CHILDREN.
VIDEO:
SOT/FULL
@ :33
Super: Dana Dabelea, M.D., Ph.D.
University of Colorado School of Medicine
Runs :12
AUDIO:
“We found that type 1 diabetes is very, very common in all racial ethnic groups, but especially in white kids.”
VIDEO:
B-ROLL
Dr. Dabelea talking with Sierra in exam room
Lab technician labeling vial of blood
C/U Sierra
Two-shot of Dr. Dabelea and Sierra in exam room
AUDIO:
DR. DANA (donna) DABELEA (duh-BAIL-ya) OF UNIVERSITY OF COLORADO SCHOOL OF MEDICINE WAS PART OF A NATIONWIDE RESEARCH GROUP, WHICH FOUND THAT KIDS WITH TYPE ONE DIABETES WERE MOST LIKELY TO BE WHITE AND DIAGNOSED BETWEEN TEN AND FOURTEEN YEARS OLD. TYPE TWO DIABETES WAS MUCH LESS COMMON.
VIDEO:
SOT/FULL
Dana Dabelea, M.D., Ph.D.
University of Colorado School of Medicine
Runs :11
AUDIO:
“Type 2 used to be called adult onset diabetes and did not used to occur in children. However, we are now seeing type 2 diabetes at younger and younger ages.”
VIDEO:
B-ROLL
Overweight black male teen at swimming pool
Obese African American female teen
Group of Hispanic teens walking outside
White teen boy riding bike
AUDIO:
TYPE TWO IS ASSOCIATED WITH OVERWEIGHT AND OBESITY, AND IS MOST COMMONLY FOUND IN AMERICAN INDIAN, AFRICAN AMERICAN AND HISPANIC TEENS, AGES 15 TO 19. DR. DABELEA SAYS CUTTING CALORIES, EATING HEALTHY FOODS AND EXERCISING REGULARLY CAN HELP PREVENT TYPE TWO DIABETES. BUT...
VIDEO:
SOT/FULL
Dana Dabelea, M.D., Ph.D.
University of Colorado School of Medicine
Runs :10
AUDIO:
“For type 1 diabetes, unfortunately there is no current prevention because unfortunately we do not know what causes type 1 diabetes yet.”
VIDEO:
B-ROLL
Sierra walking outside with her mom
AUDIO:
BEFORE SHE WAS DIAGNOSED, SIERRA’S DIABETES PUT HER INTO A COMA, BECAUSE SHE AND HER MOM DIDN’T KNOW THE WARNING SIGNS. SHE’S MEMORIZED THEM NOW:
VIDEO:
SOT/FULL
Sierra Horecky
Has type 1 diabetes
Runs :08
AUDIO:
“People should know the signs of type 1 diabetes and those signs are frequent urination, drinking a lot of water and weight loss.”
VIDEO:
B-ROLL
Crowd shots of teens outside
AUDIO:
SHE HOPES SHE CAN HELP KIDS WHO MAY ALSO FACE TYPE ONE DIABETES. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
To reach their findings, the researchers studied more than 25-hundred children and teens from across the U.S. who were newly diagnosed with diabetes. They found that the numbers of children and teens with diabetes do seem to be increasing, though they don’t have precise past numbers to make that comparison. For more information, visit www.jama.com.
