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, November 13, 2007)
JAMA NEWS RELEASES
MENTAL HEALTH NEEDS OF SOLDIERS INCREASE SEVERAL MONTHS AFTER RETURNING FROM IRAQ WAR
NUMBER OF CASES OF MOST VACCINE-PREVENTABLE DISEASES IN U.S. AT ALL-TIME LOW
SCIENTISTS INDICATE HIPAA PRIVACY RULE HAS HAD NEGATIVE INFLUENCE ON HEALTH RESEARCH
HOSPITAL QUALITY INDICATOR FOR LYMPH NODE EXAMINATION FOLLOWING COLON CANCER SURGERY DOES NOT APPEAR TO BE ASSOCIATED WITH PATIENT SURVIVAL
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
MENTAL HEALTH RE-ASSESSMENT SIX MONTHS AFTER RETURNING HOME FROM COMBAT IDENTIFIES HIGHER RATES OF SOLDIERS NEEDING HELP
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 mental health needs of U.S. soldiers several months after returning from the war in Iraq. The report will be fed Tuesday, November 13, 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, November 13, 2007
Media Advisory: To contact Charles S. Milliken, M.D., call Cynthia Vaughan at 703-681-0519.
MENTAL HEALTH NEEDS OF SOLDIERS INCREASE SEVERAL MONTHS AFTER RETURNING FROM IRAQ WAR
CHICAGO—Compared to initial screening upon returning from the Iraq war, U.S. soldiers report increased mental health concerns and needs several months after their return for problems such as posttraumatic stress disorder and depression, according to a study in the November 14 issue of JAMA.
"Our previous article described the Department of Defense’s (DoD) screening efforts to identify mental health concerns among soldiers and Marines as they return from Iraq and Afghanistan using the Post-Deployment Health Assessment (PDHA). However, the article also raised concerns that mental health problems might be missed because of the early timing of this screening. It cited preliminary data showing that soldiers were more likely to indicate mental health distress several months after return than upon their immediate return. Based on these preliminary data, the DoD initiated a second screening similar to the first, to occur 3 to 6 months after return from deployment," the authors write.
Charles S. Milliken, M.D., of Walter Reed Army Institute of Research, U.S. Army Medical Research and Materiel Command, Silver Spring, Md., and colleagues analyzed the mental health responses of the first cohort of soldiers (n = 88,235) to complete both the initial screening and the new later screening, with a median (midpoint) of six months between the two assessments. Both screenings included a self-report questionnaire and a brief interview with a clinician.
The researchers found that soldiers reported more mental health concerns, such as posttraumatic stress disorder (PTSD), major depression or alcohol misuse during the later screening. Of the 88,235 soldiers, 3,925 (4.4 percent) were referred for mental health care during the initial screening and 10,288 (11.7 percent) were referred during the later screening. Combined data from both screenings showed that the clinicians identified 20.3 percent of active and 42.4 percent of reserve soldiers as needing referral or already being under care for mental health problems.
Among active component soldiers, use of mental health services increased substantially following the later screening, especially within 30 days of the assessment. The majority of all soldiers who accessed mental health care (74 percent, n = 9,074) had not been identified as needing referral.
Concerns about interpersonal conflict increased 4-fold between the two screenings. Soldiers frequently reported alcohol concerns, yet very few were referred to alcohol treatment. Although soldiers were much more likely to report PTSD symptoms on the later screening instrument, 49 percent to 59 percent of those who had PTSD symptoms identified on the initial screen improved by the time they took the later screen, suggesting that the increase was due to new symptoms being reported.
"The study shows that the rates that we previously reported based on surveys taken immediately on return from deployment substantially underestimate the mental health burden," the authors write. "This emphasizes the enormous opportunity for a better-resourced DoD mental health system to intervene early before soldiers leave active duty."
"Increased relationship problems underscore shortcomings in services for family members. Reserve component soldiers who had returned to civilian status were referred at higher rates on the [later screening], which could reflect their concerns about their ongoing health coverage. Lack of confidentiality may deter soldiers with alcohol problems from accessing treatment. In the context of an overburdened system of care, the effectiveness of population mental health screening was difficult to ascertain."
(JAMA. 2007;298(18):2141-2148. 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, November 13, 2007
Media Advisory: To contact Sandra W. Roush, M.T., M.P.H., call Curtis Allen at 404-639-3286.
NUMBER OF CASES OF MOST VACCINE-PREVENTABLE DISEASES IN U.S. AT ALL-TIME LOW
CHICAGO—A comparison of illness and death rates for 13 vaccine-preventable diseases in the U.S., before and after use of the vaccine, indicates there have been significant decreases in the number of cases, hospitalizations and deaths for each of the diseases examined, according to a study in the November 14 issue of JAMA.
In the United States, vaccination programs have made a major contribution to the elimination of many vaccine-preventable diseases and significantly reduced the incidence of others. "Vaccine-preventable diseases have societal and economic costs in addition to the morbidity and premature deaths resulting from these diseases—the costs include missed time from school and work, physician office visits, and hospitalizations," the authors write. National recommendations provide guidance for use of vaccines to prevent or eliminate 17 vaccine-preventable diseases.
Sandra W. Roush, M.T., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues with the Vaccine-Preventable Disease Table Working Group, examined the illness and death rates before and after widespread implementation of national vaccine recommendations (in place before 2005) for 13 vaccine-preventable diseases. The diseases were diphtheria, pertussis, tetanus, poliomyelitis, measles, mumps, rubella (including congenital rubella syndrome), invasive Haemophilus influenzae type b (Hib), acute hepatitis B, hepatitis A, varicella (chickenpox), Streptococcus pneumoniae and smallpox.
For eight diseases for which a vaccine was licensed or recommended prior to 1980, the comparison of the period before national vaccination recommendations vs. the 2006 number of reported cases shows greater than 99 percent declines in the number of cases for diphtheria (100 percent), measles (99.9 percent), paralytic poliomyelitis (100 percent), rubella (99.9 percent), congenital rubella syndrome (99.3 percent), and smallpox (100 percent). Smallpox has been eradicated worldwide, and endemic transmission of poliovirus, measles virus, and rubella virus has been eliminated in the United States. There were no reported deaths due to diphtheria, measles, mumps, paralytic poliomyelitis, or rubella; deaths due to congenital rubella syndrome are not reported. The decline in cases of mumps was 95.9 percent, of tetanus 92.9 percent, and of pertussis 92.2 percent. The decline in tetanus deaths was 99.2 percent and in pertussis deaths 99.3 percent.
For five diseases for which a vaccine was licensed or recommended after 1980 but before 2005, cases of invasive Hib disease declined 99.8 percent or greater and deaths declined 99.5 percent or greater; for hepatitis A, reduction in cases was 87.0 percent, deaths 86.9 percent; a decrease of 80.1 percent in cases and 80.2 percent in deaths for acute hepatitis B; a decline of 34.1 percent in cases and 25.4 percent in deaths for invasive pneumococcal disease; and a reduction of 85.0 percent in cases and 81.9 percent in deaths for varicella. Hospitalizations declined by 87.0 percent for hepatitis A, 80.1 percent for acute hepatitis B, and 88.0 percent for varicella.
"The number of cases of most vaccine-preventable diseases is at an all-time low; hospitalizations and deaths from vaccine-preventable diseases have also shown striking decreases. These achievements are largely due to reaching and maintaining high vaccine coverage levels from infancy throughout childhood by successful implementation of the infant and childhood immunization program," the authors write.
"Vaccines are one of the greatest achievements of biomedical science and public health. Continued efforts to improve the efficacy and safety of vaccines and vaccine coverage among all age groups will provide overall public health benefit. The challenges in vaccine development, vaccine financing, surveillance, assessment, and vaccine delivery are opportunities for the future," the authors conclude.
(JAMA. 2007;298(18):2155-2163. 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, November 13, 2007
Media Advisory: To contact Roberta B. Ness, M.D., M.P.H., call Michele Baum at 412-647-3555. To contact editorial co-author Norman Fost, M.D., M.P.H., call Lisa Brunette at 608-263-5830.
SCIENTISTS INDICATE HIPAA PRIVACY RULE HAS HAD NEGATIVE INFLUENCE ON HEALTH RESEARCH
CHICAGO—About two-thirds of clinical scientists surveyed report that the HIPAA Privacy Rule for patients has had a negative influence on the conduct of health research, often adding uncertainty, cost and delays, according to a study in the November 14 issue of JAMA.
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule was intended to strike a balance between protecting the privacy of individually identifiable health information and preserving the legitimate use and disclosure of this information for important social goals, according to background information in the article. However, many researchers have expressed concerns that since implementation in April 2003, the Privacy Rule has adversely affected the progress of biomedical research.
Roberta B. Ness, M.D., M.P.H., of the University of Pittsburgh, Penn., and colleagues with the Joint Policy Committee, Societies of Epidemiology, conducted a survey to determine the degree, type, and variability of influence from the HIPAA Privacy Rule experienced by epidemiologists conducting research on U.S. human subjects (participants). Thirteen societies of epidemiology distributed a national Web-based survey and 1,527 eligible professionals anonymously answered questions.
The researchers found that regarding general perceptions of the HIPAA Privacy Rule, a majority of respondents reported that the degree to which the rule made research easier was low, at 1 to 2 (84.1 percent) on a 5-point scale (with 1 = none, 5 = a great deal), and that the degree to which the rule made research more difficult was high (67.8 percent), at 4 to 5 on the scale. Almost 40 percent indicated that the Privacy Rule increased research costs in the high range of 4 to 5, and half indicated that the additional time added by the rule to complete research projects was high.
Almost half indicated that the Privacy Rule had affected research related to public health surveillance at the high level. The perceived benefit of the rule with respect to strengthening public trust was reported as high by only 10.5 percent of respondents, and only 25.9 percent believed that the rule had enhanced participant confidentiality/privacy in the high range of 4 to 5.
Respondents also indicated that the proportion of institutional review board applications in which the Privacy Rule had a negative influence on human subjects (participants) protection was significantly greater than the proportion in which it had a positive influence.
(JAMA. 2007;298(18):2164-2170. 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: THE DYSREGULATION OF HUMAN SUBJECTS RESEARCH
Norman Fost, M.D., M.P.H., of the University of Wisconsin School of Medicine and Public Health, Madison, and Robert J. Levine, M.D., of the Yale University School of Medicine, New Haven, Conn., highlight some of the issues and problems in the current national system for protecting human research participants.
"The sources of these problems include Office for Human Research Protection and the FDA because they appear to threaten institutions with draconian penalties for minor infractions; institutional (university and other) administrators acting out of fear that their institution could be the next to have its entire research operation suspended by ‘getting caught’ in one of these minor infractions; and credentialing and certifying agencies for supporting these excesses by including them in their criteria for accreditation. A satisfactory resolution for this situation is urgently required. Resolution will necessarily require participation by federal oversight agencies, institutional officials, representatives of credentialing and certifying agencies, researchers, and research participants."
(JAMA. 2007;298(18):2196-2198. 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, November 13, 2007
Media Advisory: To contact Sandra L. Wong, M.D., M.S., call Mary Beth Reilly at 734-764-2220. To contact editorial co-author Nancy N. Baxter, M.D., Ph.D., call Christa Poole at 416-978-6974.
HOSPITAL QUALITY INDICATOR FOR LYMPH NODE EXAMINATION FOLLOWING COLON CANCER SURGERY DOES NOT APPEAR TO BE ASSOCIATED WITH PATIENT SURVIVAL
CHICAGO—Examining a specific number of lymph nodes after colon cancer surgery, a measurement that has been recommended as a quality indicator for hospitals, is not associated with length of patient survival, according to a study in the November 14 issue of JAMA.
Several studies have suggested improved survival among patients in whom a higher number of nodes are examined after colectomy for colon cancer (part or all of the colon is removed). Several organizations recently endorsed a 12-node minimum as a standard for hospital-based performance, according to background information in the article. Large private payers have already begun incorporating this measure into their pay-for-performance programs. Whether such efforts will improve outcomes for patients with colon cancer remains unclear, as is whether node counts are useful as an indicator of hospital quality.
Sandra L. Wong, M.D., M.S., of the University of Michigan, Ann Arbor, and colleagues, using data from the national Surveillance Epidemiology and End Results (SEER)-Medicare linked database (1995-2005), assessed whether hospitals’ lymph node examination rates were associated with cancer staging, use of adjuvant (supplemental) chemotherapy (indicated for patients with node-positive disease), and 5-year survival. The study included 30,625 patients undergoing colectomy for nonmetastatic colon cancer. Hospitals were ranked according to the proportion of their patients in whom 12 or more lymph nodes were examined and then were sorted into four groups. Late survival rates were assessed for each hospital group, adjusting for potentially confounding patient and clinician characteristics.
Hospitals with the highest proportions of patients with 12 or more lymph nodes examined tended to treat lower-risk patients and had substantially higher procedure volumes. After adjusting for these and other factors, there remained no statistically significant relationship between hospital lymph node examination rates and survival after surgery. Although the four hospital groups varied widely in the number of lymph nodes examined, they were equally likely to find node-positive tumors. There were no clinically important differences in the use of adjuvant chemotherapy, either overall (unadjusted rates of 26 percent for the highest hospital quartile vs. 25 percent for the lowest hospital quartile) or within cancer stage subgroups.
"Our study raises questions about the importance of examining a large number of lymph nodes in patients with colon cancer," the authors write.
Regarding the finding of no evidence of higher 5-year survival at hospitals with higher lymph node examination rates: "Our analyses also suggest a simple explanation for these null findings. Regardless of how many lymph nodes hospitals examined, they tended to find the same number of node-positive ones. As a result, higher hospital lymph node examination rates did not result in greater detection of patients with node-positive tumors or higher rates of adjuvant chemotherapy."
"Using lymph node counts as a hospital quality indicator is gaining momentum from stakeholders in the health care community," the researchers write. "The number of lymph nodes hospitals examine following colectomy for colon cancer is not associated with staging, use of adjuvant chemotherapy, or patient survival. Efforts by payers and professional organizations to increase node examination rates may have limited value as a public health intervention."
(JAMA. 2007;298(18):2149-2154. 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: LYMPH NODE COUNTS IN COLON CANCER SURGERY — LESSONS FOR USERS OF QUALITY INDICATORS
In an accompanying editorial, Marko Simunovic, M.D., M.P.H., of McMaster University, Hamilton, Ontario, Canada, and Nancy N. Baxter, M.D., Ph.D., of the University of Toronto, Ontario, Canada, comment on the findings of Wong and colleagues.
"...researchers should not abandon efforts to identify potentially useful quality indicators through various study designs. Those who use such measures and endorsing agencies must recognize the inherent weaknesses of quality indicators derived from observational data; the potential for unintended consequences as clinicians and hospitals respond in varying ways to meet perceived indicator benchmarks; and should guard against the carrot or stick use of indicators. Using quality indicators as one part of a comprehensive, supportive, incremental quality-improvement project, such as those included under the rubric of total quality management or continuous quality improvement, is likely to be more constructive—although even these strategies currently lack a compelling evidence base."
(JAMA. 2007;298(18):2194-2195. 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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JAMA REPORTS
VIDEO: Windows Media | Quicktime
MENTAL HEALTH RE-ASSESSMENT SIX MONTHS AFTER RETURNING HOME FROM COMBAT IDENTIFIES HIGHER RATES OF SOLDIERS NEEDING HELP
INTRO:
Soldiers returning from combat often bring with them mental health issues, such as depression and post-traumatic stress disorder. In an effort to diagnose and treat more soldiers, the Department of Defense instituted a new mental health screening that’s identifying a lot more soldiers in need of help. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Tom walking outside
AUDIO:
TOM WILLIAMS IS RETIRED FROM THE MILITARY NOW, BUT HE WAS IN THE MEDICAL CORPS, STATIONED IN COMBAT ZONES AND IRAQ AND AFGHANISTAN FOR MORE THAN A YEAR.
VIDEO:
SOT/FULL
@ :10
Super: Tom Williams
Retired from military
Runs :09
AUDIO:
"I spent the first six months I was back looking at the ground to make sure I didn’t get my legs blown off. And I was looking at the ground in the mall and I looked at the ground in McDonalds."
VIDEO:
B-ROLL
Department of Defense "combat" video
AUDIO:
SOLDIERS FACE ALL KINDS OF CHALLENGES READJUSTING TO CIVILIAN LIFE. SO ARMY RESEARCHERS STUDIED THE ARMY’S MENTAL HEALTH SCREENING PROGRAMS. SOLDIERS ARE SCREENED UPON RETURN FROM COMBAT, AND A NEWER PROGRAM ALSO SCREENS THEM ABOUT SIX MONTHS AFTER THEY’VE BEEN HOME.
VIDEO:
SOT/FULL
@ :33
Super: Charles Milliken, M.D.
Walter Reed Army Institute of Research
Runs :11
AUDIO:
"It picks up a second group of soldiers who were not identified on the first screen, and it’s actually a larger group of soldiers who had the mental health problems."
VIDEO:
B-ROLL
Dr. Milliken and colleagues going over data together
GFX/JAMA COVER
Full Screen Graphic
Title: Mental Health Re-Assessment
16.9% increase
"Concerned about interpersonal conflict"
Researchers again
AUDIO:
DR. CHARLES MILLIKEN AND COLLEAGUES AT WALTER REED ARMY INSTITUTE OF RESEARCH CONDUCTED THE STUDY, PUBLISHED IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. THEY FOUND THE SECOND SCREEN PICKED UP SIGNIFICANTLY MORE MENTAL HEALTH ISSUES, SUCH AS AN ALMOST SEVENTEEN PERCENTAGE POINT INCREASE IN PEOPLE WHO HAD CONCERNS ABOUT INTERPERSONAL CONFLICT IN THEIR LIVES. AND RESEARCHERS FOUND THE SECOND SCREENING, AND THE MENTAL HEALTH TRAINING THAT GOES WITH IT, MAY BE HAVING AN ADDITIONAL IMPACT.
VIDEO:
SOT/FULL
Charles Milliken, M.D.
Walter Reed Army Institute of Research
Runs :11
AUDIO:
"For the next 30 days following the screen a number of soldiers enter the mental health system. So something about the screening and training is actually encouraging soldiers to go get care."
VIDEO:
B-ROLL
Combat video ROLL THROUGH "soldiers" in following bite
AUDIO:
HE SAYS THE SUCCESS OF THAT SECOND SCREENING IS VERY IMPORTANT.
VIDEO:
SOT/FULL
Charles Milliken, M.D.
Walter Reed Army Institute of Research
Runs :11
AUDIO:
"...because we know soldiers tend to have stigma about going in to get mental health care, so something about the screening-training process is countering that stigma and making it more OK for them to get care."
VIDEO:
B-ROLL
Tom walking down hallway with uniformed soldier
AUDIO:
TOM WILLIAMS AGREES, AND SAYS THAT SECOND SCREENING JUST MAKES SENSE.
VIDEO:
SOT/FULL
Tom Williams
Military veteran
Runs :11
AUDIO:
"It takes time for reactions to start and it takes time for you to recognize that there’s something wrong, that your behaviors are not just affecting you, they’re affecting someone you probably love or care for."
VIDEO:
B-ROLL
Combat video
AUDIO:
THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
To conduct this study, the researchers reviewed mental health screening data on more than eighty-eight thousand Army soldiers. For more information, visit www.jama.com.
