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, August 21, 2007)
JAMA NEWS RELEASES
HYPERTENSION APPEARS TO BE FREQUENTLY UNDIAGNOSED IN CHILDREN AND ADOLESCENTS
STUDY COMPARES SURGICAL OPTIONS FOR SEVERE INTRA-ABDOMINAL INFLAMMATION
CLAIMS OF SEX-RELATED DIFFERENCES IN GENETIC ASSOCIATION STUDIES OFTEN NOT PROPERLY DOCUMENTED OR VALIDATED
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
HIGH BLOOD PRESSURE DIAGNOSED IN ONLY ABOUT ONE-QUARTER OF CHILDREN WHO HAVE IT
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 underdiagnosis of hypertension in children. The report will be fed Tuesday, August 21, 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.
Please Note: Because JAMA does not publish on the 5th Wednesday of a month, there will be no JAMA or news releases for August 29.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 21, 2007
Media Advisory: To contact corresponding author David C. Kaelber, M.D., Ph.D., call Rachel Pugh at 617-355-6420.
HYPERTENSION APPEARS TO BE FREQUENTLY UNDIAGNOSED IN CHILDREN AND ADOLESCENTS
CHICAGO—In a study of children and adolescents with hypertension, only about one in four had been previously diagnosed with the condition, according to a study in the August 22/29 issue of JAMA.
Hypertension, with an estimated prevalence of between 2 percent and 5 percent, is a common chronic disease in children and is increasing in prevalence with the pediatric obesity epidemic. Diagnosis of hypertension in children is complicated because normal and abnormal blood pressure values vary with age, sex, and height, according to background information in the article.
Matthew L. Hansen, M.D., of Case Western Reserve University, Cleveland, and colleagues conducted a study to determine the frequency of undiagnosed hypertension and prehypertension in 3- to 18-year-old children. The study included 14,187 children and adolescents who were observed at least three times for well-child care between June 1999 and September 2006 in outpatient clinics.
The researchers found that the criteria for hypertension were met by 507 children (3.6 percent). Of the children with hypertension, only 131 (26 percent) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record; i.e., 376 of 507 participants (74 percent) had undiagnosed hypertension. Criteria for prehypertension were met by 485 children (3.4 percent). Of these children, 55 (11 percent) had a diagnosis of hypertension or elevated blood pressure documented in the electronic medical record.
Patient characteristics significantly associated with having a diagnosis of hypertension included a 1-year increase in age over age 3, number of elevated blood pressure readings beyond three, increase of 1 percent in height-for-age percentile, having an obesity-related diagnosis, and the number of blood pressure readings in the stage 2 hypertension range. Patient characteristics significantly associated with having a diagnosis of prehypertension included a 1-year increase in age over age 3 and number of elevated blood pressure readings beyond three.
“Identification of elevated blood pressure in children meeting prehypertension or hypertension criteria is important because of the increasing prevalence of pediatric weight problems and because secondary hypertension is more common in children than adults, requiring identification and appropriate work-up. If abnormal blood pressure is not identified by a patient’s pediatric clinician, it may be years before the abnormal blood pressure is detected, leading to end-organ damage. Because effective treatments for abnormal blood pressure exist, these long-term sequelae can be avoided with early diagnosis,” the authors write.
“Although this study identifies the problem of undiagnosed hypertension in children, it also points to the potential of electronic medical records to help address this issue. The relatively poor identification of abnormal blood pressure could be remedied by a clinical decision support algorithm built into an electronic medical record that would automatically review current and prior blood pressures, ages, heights, and sex to determine if abnormal blood pressure criteria had been met. The algorithm could indicate if any abnormal blood pressure … already existed and prompt the pediatric clinician that the child appears to have undiagnosed abnormal blood pressure. In addition, the clinical decision support algorithm could provide guideline-based evaluation, treatment, and parent/patient education materials to the clinician.”
(JAMA. 2007;298(8):874-879. 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.
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, August 21, 2007
Media Advisory: To contact corresponding author Marja A. Boermeester, M.D., Ph.D., email: M.A.Boermeester{at}amc.uva.nl. To contact editorial authors E. Patchen Dellinger, M.D., or David R. Flum, M.D., M.P.H., call Clare Hagerty at 206-685-1323.
STUDY COMPARES SURGICAL OPTIONS FOR SEVERE INTRA-ABDOMINAL INFLAMMATION
CHICAGO—Performing a repeat surgery for patients with peritonitis (severe intra-abdominal inflammation or infection) only when clinical improvement is lacking may have some advantages compared with having the repeat procedure routinely scheduled after the operation, according to a study in the August 22/29 issue of JAMA.
Secondary peritonitis (inflammation involving the tissue that lines the abdominal wall and covers the intra-abdominal organs) has a high rate of death (20 percent-60 percent), long hospital stays, and high rate of illness due to the development of sepsis with multiple organ failure. Approximately 12 percent-16 percent of patients undergoing elective abdominal surgery develop postoperative peritonitis. “Health care utilization due to secondary peritonitis is extensive, with operations to eliminate the source of infection (laparotomy [surgery involving the intra-abdominal contents]) and multidisciplinary care in the intensive care unit setting,” the authors write.
The researchers add that after the initial (emergency) laparotomy, relaparotomy may be necessary to eliminate persistent peritonitis or new infections. “There are 2 widely used relaparotomy strategies: relaparotomy when the patient’s condition demands it (‘on-demand’) and planned relaparotomy. ...In the planned strategy, a relaparotomy is performed every 36 to 48 hours for inspection, drainage, and peritoneal lavage [flushing out] of the abdominal cavity until findings are negative for ongoing peritonitis.”
Oddeke van Ruler, M.D., of the Academic Medical Center, Amsterdam, and colleagues conducted a randomized trial comparing the on-demand strategy with the planned relaparotomy strategy following initial emergency surgery for patients with severe secondary peritonitis. The clinical trial was conducted at two academic and five regional teaching hospitals in the Netherlands from November 2001 through February 2005. A total of 232 patients (116 on-demand and 116 planned) were included.
The researchers found that there was no significant difference in primary end point (death and/or peritonitis-related illness within a 12-month follow-up period; 57 percent on-demand vs. 65 percent planned) or in death alone (29 percent on-demand vs. 36 percent planned) or illness alone (40 percent on-demand vs. 44 percent planned). A total of 42 percent of the on-demand patients had a relaparotomy vs. 94 percent of the planned relaparotomy group. A total of 31 percent of first relaparotomies were negative in the on-demand group vs. 66 percent were negative in the planned group.
Patients in the on-demand group had shorter median (midpoint) intensive care unit stays (7 vs. 11 days) and shorter median hospital stays (27 vs. 35 days). Direct medical costs per patient were reduced by 23 percent using the on-demand strategy.
“This randomized trial found that compared with planned relaparotomy, the on-demand strategy did not result in statistically significant reductions in the primary outcomes of death or major peritonitis-related morbidity but did result in significant reductions in the secondary outcomes of health care utilization, including the number of relaparotomies, the use of percutaneous drainage, and hospital and ICU stay,” the authors write. “Despite a lack of statistically significant improvement in primary clinical outcome, these substantial reductions in health care utilization and costs with the on-demand strategy suggest that it may be the preferred strategy.”
(JAMA. 2007;298(8):865-873. 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: TIMING OF REOPERATION FOR PATIENTS WITH SEVERE PERITONITIS
In an accompanying editorial, E. Patchen Dellinger, M.D., of the University of Washington School of Medicine, Seattle, writes that this study helps in the decision-making process regarding relaparotomy.
“The trial by van Ruler et al is the best evidence yet that mandatory or scheduled relaparotomy for peritonitis is not helpful except in the obvious settings of patients whose first procedure has resulted in retained surgical packing or because the pathology could not be dealt with completely at the first operation. What surgeons should focus on now is the search for more accurate and sensitive methods to recognize in as timely a manner as possible when a patient will need another intervention. This may include improved understanding of clinical patterns, novel imaging techniques, and possibly new biomarkers. Ultimately, though, the diligent attention of the surgical team to the clinical progress of the patient after laparotomy for peritonitis is currently the most effective management technique.”
(JAMA. 2007;298(8):923-924. 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.
EDITORIAL: WHEN NOT BEING SUPERIOR MAY NOT BE GOOD ENOUGH
Farhood Farjah, M.D., M.P.H., and David R. Flum, M.D., M.P.H., of the University of Washington, Seattle, and Contributing Editor, JAMA (Dr. Flum), comment on this trial, which examined superiority.
“Data from the well-designed and conducted superiority trial of van Ruler and colleagues will inform the design of future studies aiming to establish the superiority, inferiority, or noninferiority of on-demand compared with planned relaparotomy. While the negative results of this superiority trial may not be enough to rule out alternative interpretations, the results are consistent with the notion that an on-demand relaparotomy approach may improve outcomes and save health care resources.”
(JAMA. 2007;298(8):924-925. 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 Release: 3:00 p.m. CT, Tuesday, August 21, 2007
Media Advisory: To contact corresponding author John P.A. Ioannidis, M.D., email: jioannid{at}cc.uoi.gr.
CLAIMS OF SEX-RELATED DIFFERENCES IN GENETIC ASSOCIATION STUDIES OFTEN NOT PROPERLY DOCUMENTED OR VALIDATED
CHICAGO—A review of previous research suggests that prominent claims of sex differences of gene-disease associations are often insufficiently documented and validated, according to an article in the August 22/29 issue of JAMA.
In the human genome era, for many common diseases, published research has often considered that some common gene variants may have different effects in men vs. women. Many diseases or traits with strong genetic backgrounds have different prevalence in the two sexes and many studies try to determine differences in risks between men and women, according to background information in the article.
Nikolaos A. Patsopoulos, M.D., of the University of Ioannina School of Medicine, Ioannina, Greece and colleagues evaluated a large sample of prominently claimed sex differences for genetic effects and whether these claims were methodologically strong or were made based on selected and/or suboptimal analyses and with insufficient or questionable documentation. From a database search the authors identified 77 articles with 432 sex-difference claims.
Of these claims, 286 (66.2 percent) sex comparisons were reported as being decided a priori (in advance of the study) and 68 (15.7 percent) were acknowledged to be post hoc (after the study) analyses; in the other 78 (18.1 percent), the analysis plan was unclear. Appropriate documentation of gene-sex interaction was recorded in 55 claims (12.7 percent); documentation was insufficient for 303 claims and spurious (not valid) for the other 74. Data for reanalysis of claims were available for 188 comparisons. Of these, 83 (44.1 percent) were nominally statistically significant, and more than half of them (n = 44) failed to reach nominal statistical significance of a certain level. Of 60 claims with seemingly the best internal validity, only one was consistently replicated in at least two other studies.
“...the majority of these claims were insufficiently documented or spurious, and reporting of statistical interaction tests was rare,” the authors write.
“We hope that our empirical evaluation will help sensitize clinicians, geneticists, epidemiologists, and statisticians who are pursuing subgroup analyses by sex or other subgroups on genetic associations. The pursuit of gene-sex interactions should not be necessarily abandoned. Ideally, sex differences should be based on a priori, clearly defined, and adequately powered subgroups. Post hoc, discovery-based analyses are also of interest, but their post hoc character should be clearly stated in the manuscript. Both a priori and post hoc claims should be documented by interaction tests and proper consideration of the multiplicity of comparisons involved. Even then, results should be explained with caution and should be replicated by several other studies before being accepted as likely modifications of genetic or other risks.”
(JAMA. 2007;298(8):880-893. 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.
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
HIGH BLOOD PRESSURE DIAGNOSED IN ONLY ABOUT ONE-QUARTER OF CHILDREN WHO HAVE IT
INTRO:
High blood pressure is something you may not associate with children, but some kids do have it, and it can mean serious health problems. A new study says pediatricians need to pay more attention to this issue, because there are likely about a million children in the U.S. who have high blood pressure, but whose doctors have not diagnosed it. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
SOT/FULL
@ :02
Super: David Kaelber, M.D., Ph.D.
Children’s Hospital Boston
Runs :11
AUDIO:
“I think the normal assumption is, is that well if a child has a disease the pediatric provider is going to figure it out. And what this study shows is that, that is really not the case.”
VIDEO:
B-ROLL
Dr. Kaelber taking a child’s blood pressure
Cutaway child
Dr. Kaelber
AUDIO:
SURPRISING NEWS ABOUT HIGH BLOOD PRESSURE IN KIDS, COMING FROM DR. DAVID KAELBER (KELL-ber), WHO HIMSELF TREATS CHILDREN.
VIDEO:
SOT/FULL
David Kaelber, M.D., Ph.D.
Children’s Hospital Boston
Runs :15
AUDIO:
“And it’s not that we’re just missing a couple percent, maybe a couple hundred patients. We’re really missing a huge percentage of patients with this disease. In fact, the overwhelming majority of patients with this disease, we’re not detecting it.”
VIDEO:
B-ROLL
Let bite run through name
Exterior of hospital
GFX/JAMA COVER
Close up blood pressure cuff
Cutaway reading on machine
AUDIO:
DR. KAELBER, OF CHILDREN’S HOSPITAL IN BOSTON, IS AN AUTHOR OF THE STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. THE STUDY FOUND THAT ONLY ABOUT A QUARTER OF KIDS WHO HAVE HIGH BLOOD PRESSURE ARE BEING DIAGNOSED.
VIDEO:
SOT/FULL
David Kaelber, M.D., Ph.D.
Children’s Hospital Boston
Runs :10
AUDIO:
“To try to simplify this as much as possible, the more the child was like an adult, the more likely it was that their blood pressure would have been picked up.”
VIDEO:
B-ROLL
Teens walking down hill
Nurse taking child’s blood pressure
Dr. Kaelber and colleague talking at desk/computer
Child wearing blood pressure cuff
AUDIO:
IN OTHER WORDS, CHILDREN WHO WERE OLDER, TALLER AND HEAVIER WERE MORE LIKELY TO HAVE THEIR HIGH BLOOD PRESSURE DIAGNOSED. BUT THOSE AREN’T THE ONLY KIDS WHO HAVE HIGH BLOOD PRESSURE. STILL, EVEN IF PEDIATRICIANS WANT TO FOCUS ON THIS ISSUE, IT’S ACTUALLY VERY COMPLICATED TO DIAGNOSE HIGH BLOOD PRESSURE IN KIDS.
VIDEO:
SOT/FULL
David Kaelber, M.D., Ph.D.
Children’s Hospital Boston
Runs :07
AUDIO:
“The challenge here is that there’s literally hundreds of normal and abnormal blood pressure values for children.”
VIDEO:
B-ROLL
Dr. Kaelber and colleague at computer discussing data
AUDIO:
BUT DR. KAELBER SAYS PEDIATRICIANS SHOULD MAKE THE EFFORT, BECAUSE HIGH BLOOD PRESSURE CAN BE A SIGN OF SERIOUS ILLNESS, OR MAY LEAD TO HEALTH PROBLEMS LATER IN LIFE.
VIDEO:
SOT/FULL
David Kaelber, M.D., Ph.D.
Children’s Hospital Boston
Runs :06
AUDIO:
“Hopefully this study will be seen as a wake-up call both for providers and really for parents and patients.”
VIDEO:
B-ROLL
Close-up of girl’s face
AUDIO:
THIS CHILD’S MOM AGREES.
VIDEO:
SOT/FULL
@ 1:32
Super: Delores Ellison-Moss
Parent
Runs :05
AUDIO:
“I think it’s good for them to get their blood pressure checked because you never know what’s going on.”
VIDEO
B-ROLL
Different child having blood pressure taken
AUDIO:
AND DOCTORS AND PARENTS NEED TO KNOW IF KIDS DO HAVE HIGH BLOOD PRESSURE. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
To conduct this study, the researchers reviewed seven years of electronic medical records for about 15-thousand children, ages three to eighteen. They compared blood pressure data in the records to the number of actual diagnoses. For more information, visit www.jama.com.
