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, October 9, 2007)
JAMA NEWS RELEASES
MEDICATION SHOWS PROMISE AS A TREATMENT FOR ALCOHOL DEPENDENCE
CHRONIC JOB STRAIN AFTER HEART ATTACK ASSOCIATED WITH INCREASED RISK FOR ANOTHER CORONARY HEART DISEASE EVENT
PROGRAMS SHOW SHORT-TERM BENEFITS IN HELPING CHILDREN MAINTAIN WEIGHT LOSS
COMPARISON OF MANAGED CARE PROGRAMS SUGGESTS MEDICAID PATIENTS RECEIVE LOWER-QUALITY CARE THAN PATIENTS IN COMMERCIAL PROGRAMS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STRESSFUL JOBS MAY INCREASE THE RISK OF RECURRENT HEART ATTACK
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TV Note: This week's JAMA Report video is on job strain and the risk of recurrent coronary heart disease events. The report will be fed Tuesday, October 9, 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 14, downlink frequency: 3880 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, October 9, 2007
Media Advisory: To contact Bankole A. Johnson, D.Sc., M.D., Ph.D., call Mary Jane Gore at 434-924-9241. To contact editorial author Mark L. Willenbring, M.D., call John Bowersox at 301-443-3860.
MEDICATION SHOWS PROMISE AS A TREATMENT FOR ALCOHOL DEPENDENCE
CHICAGO—Alcohol-dependent patients who received the medication topiramate had fewer heavy drinking days, fewer drinks per day and more days of continuous abstinence than those who received placebo, according to a study in the October 10 issue of JAMA.
According to background information in the article, a previous, shorter trial indicated that topiramate, a medication used in the treatment of seizures, may be beneficial for the treatment of alcohol dependence.
Bankole A. Johnson, D.Sc., M.D., Ph.D., of the University of Virginia, Charlottesville, Va., and colleagues conducted a multisite, 14-week, randomized controlled trial to determine the efficacy of topiramate compared with placebo. The study, which included 371 men and women age 18 to 65 years diagnosed with alcohol dependence, was conducted between January 2004 and August 2006 at 17 U.S. sites. The participants received up to 300 mg/day of topiramate (n = 183) or placebo (n = 188), along with a weekly psychosocial treatment to promote adherence with the study medication and the treatment regimen.
Treating all dropouts as relapse to baseline, topiramate compared with placebo recipients showed greater reduction of percentage of heavy drinking days from baseline to week 14 (from an average of 81.9 percent to 43.8 percent for topiramate vs. 82.0 percent to 51.8 percent for placebo; average difference, 8.44 percent). Prespecified analysis also showed that topiramate compared with placebo decreased the percentage of heavy drinking days (average difference, 16.19 percent).
The researchers also found that topiramate compared with placebo treatment was associated with a significantly higher rate of achieving 28 or more days of continuous nonheavy drinking and 28 or more days of continuous abstinence. Adverse events that were more common with topiramate vs. placebo included paresthesia (abnormal skin sensations), taste perversion, anorexia, and difficulty with concentration.
“Our finding in this study that topiramate is a safe and consistently efficacious medication for treating alcohol dependence is scientifically and clinically important. Alcoholism ranks third and fifth on the U.S. and global burdens of disease, respectively. Discovering pharmacological agents such as topiramate that improve drinking outcomes can make a major contribution to global health. Because topiramate pharmacotherapy can be paired with a brief intervention deliverable by nonspecialist health practitioners, a next step would be to examine its efficacy in community practice settings,” the authors conclude.
(JAMA. 2007;298(14):1641-1651. 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: MEDICATIONS TO TREAT ALCOHOL DEPENDENCE — ADDING TO THE CONTINUUM OF CARE
In an accompanying editorial, Mark L. Willenbring, M.D., of the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Md., writes that alcohol dependence is a disease that needs greater attention in the health care community.
“Alcohol dependence is the third leading modifiable cause of death in the United States, accounting for about 85,000 deaths per year. Reducing incidence, shortening the course, and reducing the severity of episodes are valuable and important goals. Reducing the public health burden will involve addressing the needs of a broader range of patients than can be treated by the specialty treatment system. In particular, it will be important to reduce disability caused by currently untreated episodes of dependence among those with the nonrelapsing form of the illness.”
“By historical standards, the pace of medication development for treating this disorder is increasing, and a variety of medications with different modes of action are now available. A solid understanding of the neurobiology of alcohol addiction is providing the framework for multiple avenues of further medication development. The behavioral platform required to support medication treatment is similar to that for depression, attention-deficit/hyperactivity disorder, diabetes, and other chronic illnesses, and thus could potentially fit into general medical practice.”
(JAMA. 2007;298(14):1691-1692. 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, October 9, 2007
Media Advisory: To contact corresponding author Chantal Brisson, Ph.D., call Jean-François Huppé
at 418-656-7785. To contact editorial author Kristina Orth-Gomér, M.D., email: kristina.orth-gomer{at}ki.se.
CHRONIC JOB STRAIN AFTER HEART ATTACK ASSOCIATED WITH INCREASED RISK FOR ANOTHER CORONARY HEART DISEASE EVENT
CHICAGO—Persons who reported chronic job strain after a first heart attack (myocardial infarction) had about twice the risk of experiencing another coronary heart disease event such as heart attack or unstable angina than those without chronic job strain, according to a study in the October 10 issue of JAMA.
Several studies have shown that job strain increases the risk of a first coronary heart disease (CHD) event. However, little is known about the association of job strain on the risk of recurrent CHD events, according to background information in the article.
Corine Aboa-Èboulé, M.D., Ph.D., of the Université Laval, Québec, Canada, and colleagues conducted a study to determine whether job strain increases the risk of recurrent CHD events after a first heart attack. The study included 972 men and women, age 35 to 59 years, who returned to work after a first heart attack and were then followed up between February 1996 and June 2005. Patients were interviewed at baseline (on average, 6 weeks after their return to work), then after 2 and 6 years subsequently. Job strain was defined and determined by the degree of high psychological demands and low decision control.
During the average follow-up of 5.9 years, 206 patients had a confirmed recurrent CHD event (111 nonfatal heart attack, 82 unstable angina, and 13 fatal CHD). Chronic job strain was associated with a 2-fold increase in the risk of recurrent CHD events even after adjustment for 26 potentially confounding CHD-risk factors and sociodemographic, lifestyle, and clinical-prognostic and work-environment characteristics. There were no significant statistical interactions between chronic job strain and either sex, age, marital status, education, perceived economic situation and chronic low social support at work.
“These results suggest that preventive interventions aimed at reducing job strain might have a significant impact on recurrent CHD events. Although further studies are required to establish optimal interventions, information about the results of this study should be disseminated in cardiac practice and in occupational health services with the aim of reducing job strain for workers returning to work after [a heart attack],” the authors write.
(JAMA. 2007;298(14):1652-1660. 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: JOB STRAIN AND RISK OF RECURRENT CORONARY EVENTS
There needs to be a greater emphasis on evaluating job strain, writes Kristina Orth-Gomér, M.D., of the Karolinska Institutet, Stockholm, Sweden, in an accompanying editorial.
“Job strain and other related psychosocial risk factors are associated with worse prognosis in patients with coronary heart disease. These influences are independent of standard risk factors and need to be addressed in clinical practice. However, knowledge is lacking on how to prevent and manage job strain in particular and psychosocial risk in general. Therefore, there is a great need for research on methods and interventions to deal with these risk factors in the clinical setting.”
“Patients and physicians may benefit from widening the medical framework to include job strain evaluation. If physicians have difficulty finding adequate time to discuss job experiences with patients, this role may be adopted by other health care professionals, such as experienced cardiac rehabilitation nurses. Patients are often relieved and may spontaneously report improved quality of life and increased capacity for coping once they have their concerns assessed.”
(JAMA. 2007;298(14):1693-1694. 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, October 9, 2007
Media Advisory: To contact Denise E. Wilfley, Ph.D., call Jim Dryden at 314-286-0110. To contact editorial co-author David S. Ludwig, M.D., Ph.D., call Andrea Duggan at 617-919-3110.
PROGRAMS SHOW SHORT-TERM BENEFITS IN HELPING CHILDREN MAINTAIN WEIGHT LOSS
CHICAGO—Children who lost weight were able to keep it off more effectively by participating in maintenance treatment programs that emphasized behavioral skills or social facilitation, although the effectiveness lessened over time, according to a study in the October 10 issue of JAMA.
The prevalence of overweight among children in the United States has tripled in recent decades and related health care costs have nearly quadrupled, according to background information in the article. “Lifestyle interventions remain the most well-established interventions for overweight 7- to 12-year-olds. Although some evidence supports long-term efficacy, maintaining weight loss remains a challenge, with most interventions marked by considerable relapse,” the authors write.
Denise E. Wilfley, Ph.D., of Washington University School of Medicine, St. Louis, and colleagues evaluated the effects of two interventions following standard family-based behavioral weight loss treatment: a behavioral skills maintenance (BSM) and a social facilitation maintenance (SFM) intervention, compared to no intervention.
The BSM approach is based on the premise that specific strategies are needed for weight loss maintenance, emphasizing self-regulation behaviors and relapse-prevention strategies. The SFM approach is based on the premise that relapse results from the absence of a social environment supportive of continued weight control. This approach also targets peer (e.g., teasing) and self-perceptual (e.g., body image) factors identified as barriers to overweight children’s physical activity.
The randomized controlled trial, conducted between October 1999 and July 2004 in a university-based weight control clinic, included 204 healthy 7- to 12-year-olds, 20 percent to 100 percent above median (midpoint) body mass index (BMI) for age and sex, with at least one overweight parent. Children enrolled in five months of weight loss treatment and 150 were randomized to one of three maintenance conditions: control group or four months of BSM or SFM treatment. Follow-up assessments occurred immediately following maintenance treatments and 1 and 2 years following randomization.
The researchers found that children receiving either BSM or SFM maintained relative weight significantly better than children assigned to the control group from randomization to postweight maintenance. Active maintenance treatment effectiveness relative to the control group declined during follow-up, but the effects of SFM alone and when analyzed together with BSM were significantly better than the control group when examining certain BMI score outcomes from baseline to 2-year follow-up. Baseline child social problem scores moderated child relative weight change from baseline to 2-year follow-up, with low social problem children in SFM vs. the control group having the best outcomes. There were no significant differences in child weight outcomes between BSM and SFM in either the short-term or long-term.
“The alarming prevalence of child overweight necessitates the development of more effective long-term intervention strategies. Our study demonstrated that extended treatment contact with either a continued BSM focus or a novel SFM focus improves weight loss maintenance in a childhood overweight population in comparison with a weight loss program alone at least in the short-term, with some evidence for sustained long-term efficacy among more socially adept children receiving an SFM treatment,” the researchers write.
(JAMA. 2007;298(14):1661-1673. 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: CHILDHOOD OBESITY AS A CHRONIC DISEASE — KEEPING THE WEIGHT OFF
In an accompanying editorial, Erinn T. Rhodes, M.D., M.P.H., and David S. Ludwig, M.D., Ph.D., of Children’s Hospital Boston and Harvard Medical School, comment on the study by Wilfley and colleagues.
“Improving outcomes for childhood obesity requires ongoing research to identify optimal dietary and lifestyle strategies, the behavioral interventions necessary to promote them, and their dose-response relationship in different clinical settings. Wilfley et al have provided a useful starting point. Ultimately, the environment in which these interventions are applied also must be considered. For greatest benefit, family-based approaches to obesity should be coupled with interventions in the school and in the community, while even broader efforts focus on the ways in which food marketing can be used to promote rather than jeopardize children’s health.”
(JAMA. 2007;298(14):1695-1696. 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, October 9, 2007
Media Advisory: To contact Bruce E. Landon, M.D., M.B.A., call Alyssa Kneller at 617-432-0442.
COMPARISON OF MANAGED CARE PROGRAMS SUGGESTS MEDICAID PATIENTS RECEIVE LOWER-QUALITY CARE THAN PATIENTS IN COMMERCIAL PROGRAMS
CHICAGO—Medicaid managed care enrollees appear to receive lower-quality care than patients enrolled in commercial managed care programs, according to a study in the October 10 issue of JAMA.
“Although enrollment of commercially insured individuals in health maintenance organizations (HMOs) has decreased in recent years, HMOs continue to provide care for an increasing proportion of the Medicaid population. Between 1994 and 2004, enrollment in Medicaid managed care tripled from 7.9 million beneficiaries to more than 27 million beneficiaries. The proportion of Medicaid beneficiaries in managed care increased from 23 percent to more than 60 percent during the same time period,” the authors write. There is limited information in peer-reviewed literature on the quality of care delivered within health plans to Medicaid enrollees.
Bruce E. Landon, M.D., M.B.A., of Harvard Medical School, Boston, and colleagues examined performance on 11 Healthcare Effectiveness Data and Information Set (formerly the Healthplan Employer Data and Information Set) (HEDIS) quality indicators in three types of managed care plans: Medicaid-only plans, commercial-only plans (health plans serving predominantly commercial enrollees), and Medicaid/commercial plans (health plans serving substantial numbers of both types of enrollees). The 11 indicators were in the categories of prevention and screening (such as breast cancer screening); chronic disease management (such as high blood pressure); and care for pregnant women.
The study included 383 health plans that reported quality-of-care data to the National Committee for Quality Assurance for 2002 and 2003, including 204 commercial-only plans; 142 Medicaid/commercial plans; and 37 Medicaid-only plans.
When comparing the quality of care indicators for the Medicaid and commercial populations together, overall commercial population performance exceeded overall Medicaid population performance in all instances except one, ranging from a difference of 4.9 percent for controlling hypertension (58.4 percent for commercial vs. 53.5 percent for Medicaid) to 24.5 percent for rates of appropriate postpartum care (77.2 percent for commercial vs. 52.7 percent for Medicaid). The one exception was chlamydia screening, for which Medicaid performance exceeded commercial performance (41.8 percent vs. 25.3 percent). When comparing performance for Medicaid and commercial populations within the same health plan, performance for the commercial population was uniformly better across all measures.
Among Medicaid enrollees, performance on the 11 measures observed in this study were comparable for Medicaid-only plans and Medicaid/commercial plans. Similarly, among commercial enrollees, there was virtually no difference in performance between health plans that served only the commercial population and those that also served the Medicaid population.
“These findings suggest that the type of health plan enrolling the population (commercial, Medicaid/commercial, or Medicaid-only) is a less important determinant of the quality of care than differences in the characteristics of the population being served, the local provider networks in which they receive care, access to care, patterns of care seeking, and adherence to treatment recommendations,” the researchers write.
(JAMA. 2007;298(14):1674-1681. 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
STRESSFUL JOBS MAY INCREASE THE RISK OF RECURRENT HEART ATTACK
INTRO:
Doctors know that healthy eating and exercise can help people who’ve had a heart attack prevent having another one. But a new study says that a stressful work environment can also play a role in increasing the risk of another heart attack. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Michel working at desk
AUDIO:
MICHEL HEROUX (michelle ay-ROO) HAD A HEART ATTACK IN 1996, AND THEN WENT BACK TO HIS VERY STRESSFUL EXECUTIVE JOB.
VIDEO:
SOT/FULL
@ :08
Super: Michel Heroux
Has had two heart attacks
Runs :08
AUDIO:
“In that kind of job you cannot make many mistakes and every time the boss talks to you the level of stress increases.”
VIDEO:
B-ROLL
More Michel at work
AUDIO:
BUT IN 2005, MICHEL HAD ANOTHER HEART ATTACK. HIS DOCTOR SAID:
VIDEO:
SOT/FULL
Michel Heroux
Has had two heart attacks
Runs :05
AUDIO:
“Stress is killing you. You don’t have anymore the arteries in the heart to go on in a very stressful environment.”
VIDEO:
B-ROLL
People getting on train GFX/JAMA COVER
AUDIO:
MICHEL IS NOT ALONE, ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :34
Super: Chantal Brisson, Ph.D.
Laval University, Quebec
Runs :10
AUDIO:
“Those who returned to work in a stressful job had two times the risk of a new heart attack, compared to those who returned to a low-stress job.”
VIDEO:
B-ROLL
Dr. Brisson and colleagues at computer
At stressful job, worker in power plant taking readings
AUDIO:
DR. CHANTAL (shan-TAL) BRISSON (brih-SON) AND COLLEAGUES AT LAVAL (la-VAL) UNIVERSITY IN QUEBEC WERE AMONG THE RESEARCHERS WHO STUDIED ALMOST A THOUSAND HEART ATTACK PATIENTS, TO SEE WHO HAD SECOND HEART ATTACKS, AND WHO HAD STRESSFUL JOBS.
VIDEO:
SOT/FULL
Chantal Brisson, Ph.D.
Laval University, Quebec
Runs :16
AUDIO:
“A stressful work situation is when a person has to do a large amount of work in a short amount of time and at the same time, has little leeway to make decisions and to be creative in his job.”
VIDEO:
B-ROLL
Women/operators on phone/at computers
Different power plant worker at computer
reverse/through window
AUDIO:
OBVIOUSLY THIS TYPE OF STRESS IS PRESENT IN MANY JOBS TO VARIOUS DEGREES, BUT DR. BRISSON SAYS HEART ATTACK PATIENTS WHO RETURN TO STRESSFUL JOBS SHOULD ASK FOR HELP REDUCING WORK STRESS.
VIDEO:
SOT/FULL
Chantal Brisson, Ph.D.
Laval University, Quebec
Runs :16
AUDIO:
“When work is organized in a way that there is some stress but not too much and that people remain healthy, that is also beneficial for the company.”
VIDEO:
B-ROLL
Michel at desk working
AUDIO:
MICHEL DECIDED TO REDUCE HIS STRESS, AND WAS ABLE TO FIND A JOB AT THE SAME PLACE, AT THE SAME PAY.
VIDEO:
SOT/FULL
Michel Heroux
Has had two heart attacks
Runs :08
AUDIO:
“I work only 2 and a half days a week because I am a semi-retired person, so the level of stress has been lowered very considerably.”
VIDEO:
B-ROLL
Woman working at computer
Crowd/people walking outside, no faces showing
AUDIO:
HE SAYS HE HOPES OTHER WORKERS CAN MAKE THE SAME CHOICES HE DID, ESPECIALLY IF THEY’RE AT RISK FOR A SECOND HEART ATTACK. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The study authors say that increased risk of heart attack was present for heart attack patients in stressful jobs regardless of the severity of their first heart attack, what medications they were on, what other medical conditions they had, whether they smoked, or their family history. For more information, visit www.jama.com.
