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 20, 2007)
JAMA NEWS RELEASES
OBESITY ASSOCIATED WITH LOWER PSA LEVELS IN MEN WITH PROSTATE CANCER
ADDING RAPID RESPONSE MEDICAL TEAM IN A CHILDREN’S HOSPITAL HELPS REDUCE RISK OF DEATH, RATES OF CARDIAC AND RESPIRATORY ARREST
USE OF PEDOMETER ASSOCIATED WITH INCREASED PHYSICAL ACTIVITY, DECREASED BLOOD PRESSURE AND WEIGHT
MANY EMPLOYERS DO NOT APPEAR TO BE IMPLEMENTING STRATEGIES AND PROGRAMS TO IMPROVE THE QUALITY AND VALUE OF HEALTH BENEFITS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
PEDOMETERS SHOWN TO INCREASE PHYSICAL ACTIVITY AND IMPROVE HEALTH
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TV Note: This week's JAMA Report video is on the use of pedometers and the effect on physical activity and health. The report will be fed Tuesday, November 20, 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 20, 2007
Media Advisory: To contact corresponding author Stephen J. Freedland, M.D., call Lauren Shaftel Williams at 919-684-4966.
OBESITY ASSOCIATED WITH LOWER PSA LEVELS IN MEN WITH PROSTATE CANCER
CHICAGO—Higher body mass index (BMI) is associated with higher plasma volume, which may be related to lower prostate-specific antigen (PSA) levels among obese men, according to a study in the November 21 issue of JAMA.
Recent evidence has suggested that prostate cancer screening may be adversely affected by increased BMI. The ability to accurately detect prostate cancer can be compromised by any factor that decreases PSA concentration in the circulation, according to background information in the article. Several studies have found that obese men have lower PSA concentrations than non-obese men. "However, men with higher BMIs also have larger plasma volumes, which could decrease serum concentrations of soluble tumor markers—a phenomenon known as hemodilution," the authors write.
Lionel L. Bañez, M.D., of Duke University Medical Center, Durham, N.C., and colleagues conducted a study to determine the association between hemodilution and PSA concentration in obese men with prostate cancer. The study consisted of men who underwent radical prostatectomy for prostate cancer from 1988 to 2006 and who were included in the databases of the Shared Equal Access Regional Cancer Hospital (n = 1,373), Duke Prostate Center (n = 1,974), and Johns Hopkins Hospital (n = 10,287).
The researchers found that higher BMI was significantly associated with greater plasma volume in all study populations. Men with a BMI of 35 or greater had 21 percent to 23 percent larger plasma volumes relative to normal-weight men. After adjusting for multiple clinicopathological variables, higher BMI was associated with lower pre-operative PSA concentrations in the groups. Men with a BMI of 35 or greater had 11 percent to 21 percent lower PSA concentrations relative to normal-weight men.
"In 3 distinct prostate cancer cohorts, all treated by radical prostatectomy, hemodilution from increased plasma volume may be responsible for the observed decreased PSA concentration in men with higher BMI. This association needs to be confirmed prospectively in screened populations that include men without prostate cancer," the authors conclude.
(JAMA. 2007;298(19):2275-2280. 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 20, 2007
Media Advisory: To contact Paul J. Sharek, M.D., M.P.H., call Krista Conger at 650-725-5371. To contact editorial co-author Richard J. Brilli, M.D., call Jim Feuer at 513-636-4656.
ADDING RAPID RESPONSE MEDICAL TEAM IN A CHILDREN’S HOSPITAL HELPS REDUCE RISK OF DEATH, RATES OF CARDIAC AND RESPIRATORY ARREST
CHICAGO—A children’s hospital that added a rapid response medical team for patients not in the intensive care unit saw an 18 percent decrease in the death rate, and about a 70 percent decline in the rate of cardiac and respiratory arrests, according to a study in the November 21 issue of JAMA.
Introduction of a rapid response team (RRT; medical emergency team) has been shown to decrease death and cardiopulmonary arrests outside of the intensive care unit (ICU) in adult inpatients, according to background information in the article. An RRT is a multidisciplinary team frequently consisting of ICU-trained personnel who are available 24 hours per day, 7 days per week for evaluation of patients not in the ICU who develop signs or symptoms of clinical deterioration.
"The RRT intervention was developed in response to research that revealed adult patients on general medical and surgical hospital units often have evidence of physiological deterioration several hours before cardiopulmonary arrest, and that after a cardiac arrest occurred, survival rates were poor. Given that there appears to be a window of opportunity to identify and proactively treat ‘prearrest’ adult inpatients effectively, the Institute for Healthcare Improvement recommended RRTs be implemented nationwide in an effort to decrease inpatient mortality rates," the authors write. Limited data exist evaluating the effectiveness of RRT implementation in pediatric inpatients.
Paul J. Sharek, M.D., M.P.H., of Stanford University School of Medicine, Palo Alto, Calif., and colleagues evaluated whether RRT implementation was associated with decreases in hospital-wide mortality rates and code rates (respiratory and cardiopulmonary arrests) outside of the ICU in pediatric inpatients at a 264-bed academic children’s hospital. Pediatric inpatients who spent at least one day on a medical or surgical ward between January 2001 and March 2007 were included. A total of 22,037 patient admissions were evaluated pre-intervention (before September 1, 2005), and 7,257 patient admissions were evaluated post-intervention (on or after September 1, 2005).
A significant decrease of 18 percent occurred in the hospital-wide mortality rate after implementation of the RRT. The rate of codes outside of the ICU setting per 1,000 eligible admissions declined by 71.7 percent, with pre-intervention and post-intervention rates of 2.45 vs. 0.69, respectively. The rate of codes outside of the ICU per 1,000 eligible patient-days decreased by 71.2 percent after RRT implementation.
The RRT intervention, using statistical modeling, was associated with a decrease of 0.178 deaths per 100 discharges or 1.78 deaths per 1,000 discharges. During the 19-month post-intervention period, the RRT intervention is estimated to have resulted in 33 lives saved at this hospital.
"Implementation of an RRT in our free-standing, quaternary care academic children’s hospital was associated with statistically significant reductions in hospital-wide mortality rates and code rates outside of the ICU setting. These reductions cannot be explained by differences in patient characteristics or severity of illness between the control and post-intervention populations," the authors write.
"The potential implications of these findings on national mortality rates for children are dramatic. Future research should focus on replicating these findings in other pediatric inpatient settings, including settings where children are treated in predominantly adult-focused hospitals, developing efficient methods for implementing RRTs, and evaluating the cost-effectiveness of this intervention."
(JAMA. 2007;298(19):2267-2274. 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: PEDIATRIC RAPID RESPONSE TEAMS — IS IT TIME?
In an accompanying editorial, Jeffrey E. Nowak, M.D., and Richard J. Brilli, M.D., of the University of Cincinnati College of Medicine, comment on the findings of Sharek and colleagues.
"The data on RRT outcomes in pediatric hospitals are increasing and thus far suggest benefit. Sharek et al have provided the most persuasive data to date regarding the efficacy of pediatric RRTs – a mortality benefit. Nonetheless, the challenge remains to collect rigorous and comparable data, whether beneficial effects are demonstrated or not, so the optimal approach for RRTs in pediatrics can be determined."
(JAMA. 2007;298(19):2311-2312. 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 20, 2007
Media Advisory: To contact Dena M. Bravata, M.D., M.S., call Michelle Brandt at 650-723-0272.
USE OF PEDOMETER ASSOCIATED WITH INCREASED PHYSICAL ACTIVITY, DECREASED BLOOD PRESSURE AND WEIGHT
CHICAGO—A review of previous studies indicates that use of a pedometer, especially with a daily step goal, is associated with significant increases in physical activity (additional walking of about a mile a day) and decreases in body mass index and blood pressure, according to an article in the November 21 issue of JAMA.
More than half of all adults in the United States do not get adequate physical activity and approximately one-quarter do not get any leisure time physical activity, according to background information in the article. "The costs associated with physical inactivity are high. For example, if 10 percent of adults in the United States began a regular walking program, an estimated $5.6 billion in heart disease costs could be saved," the authors write. Pedometers are small, relatively inexpensive devices worn at the hip to count the number of steps walked per day. Although there is not detailed evidence of their effectiveness, they have recently experienced a surge in popularity as a tool for motivating and monitoring physical activity.
Dena M. Bravata, M.D., M.S., of Stanford University, Calif., and colleagues evaluated the association between pedometer use and physical activity and health outcomes among adults. The authors searched databases for studies and articles on this topic, and identified 26 studies with a total of 2,767 participants that met inclusion criteria (eight randomized controlled trials [RCTs] and 18 observational studies). The participants’ average age was 49 years and 85 percent were women. The average intervention duration was 18 weeks.
In the RCTs, pedometer users significantly increased their physical activity by 2,491 steps per day more than control participants. Among the observational studies, pedometer users significantly increased their physical activity by 2,183 steps per day over baseline (2,000 steps is about one mile). Overall, pedometer users increased their physical activity by 26.9 percent over baseline. Among the intervention characteristics, having a step goal was the key predictor of increased physical activity. The three studies that did not include a step goal had no significant improvement in physical activity with pedometer use in contrast to increases of more than 2,000 steps per day with the use of a 10,000-step-per-day goal or other goal.
Intervention participants significantly decreased their body mass index by 0.38 from baseline. This reduction was associated with older age and having a step goal. Participants also significantly decreased their systolic blood pressure by 3.8 mm Hg, which was associated with greater systolic blood pressure at baseline and change in steps per day.
"Our results suggest that the use of these small, relatively inexpensive devices is associated with significant increases in physical activity and improvements in some key health outcomes, at least in the short term. The extent to which these results are durable over the long term is unknown," the researchers write.
(JAMA. 2007;298(19):2296-2304. 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 20, 2007
Media Advisory: To contact Meredith B. Rosenthal, Ph.D., call Todd Datz at 617-432-3952.
MANY EMPLOYERS DO NOT APPEAR TO BE IMPLEMENTING STRATEGIES AND PROGRAMS TO IMPROVE THE QUALITY AND VALUE OF HEALTH BENEFITS
CHICAGO—A new survey indicates that among large employers, many have not examined data on physician quality or shared health plan or physician data with employees that could help improve the value and quality of health benefits, according to a study in the November 21 issue of JAMA.
"Value-based purchasing has often been portrayed as the lynchpin to quality improvement in a market-based health care system. Under this paradigm as it was originally conceived, employers and other large purchasers of health care are expected to contract with health plans according to quality and cost. Other key elements of value-based purchasing include the promotion of quality improvement in negotiations with health plans and facilitating informed choice of health plan through dissemination of comparative cost and quality information to employees," the authors write. Although a small group of the largest national employers have been active in improving health care quality through the promotion of quality measurement, reporting, and pay for performance, it is unknown whether these ideas have significantly effected employer-sponsored health benefit purchasing.
Meredith B. Rosenthal, Ph.D., of the Harvard School of Public Health, Boston, and colleagues conducted a national survey of large employers regarding value-based purchasing of health care and related efforts to improve the quality of health care and employee health. The researchers interviewed by telephone executives at 609 of the largest employers across 41 U.S. markets between July 2005 and March 2006. The 41 randomly selected markets have at least 100,000 persons enrolled in health maintenance organizations, include approximately 91 percent of individuals enrolled in health maintenance organizations nationally, and represent roughly 78 percent of the U.S. metropolitan population. The 26 largest employers were identified in each market, with firms ranging in size from 60 to 250,000 employees.
A large percentage of surveyed executives reported that they examine health plan quality data (269 respondents; 65 percent), but few reported using it for performance rewards (49 respondents; 17 percent) or to influence employees (71 respondents; 23 percent). Physician quality information is less commonly examined (71 respondents; 16 percent) or used by employers to reward performance (8 respondents; 2 percent) or influence employee choice of providers (34 respondents; 8 percent).
"Our study suggests that skepticism about the benefits of value-based purchasing may be important because only about one-third of employers viewed each value-based purchasing strategy we asked about as ‘very useful.’ This perception may be due to the lack of a ‘business case’ for the intended outcomes of value-based purchasing in terms of the effects on workforce productivity, benefit cost savings, or the ability to attract and retain employees. Alternatively, some employers may (correctly) perceive that the evidence to support the effectiveness of strategies such as pay for performance and report cards is mixed at best," the authors write.
"During the last decade, a number of high-profile employers have become involved in delivery system reform and quality improvement in national and local spheres. Nonetheless, our findings suggest that employers as a whole do not appear to be directly implementing contracting strategies and programs to improve the quality and value of health benefits, except as they relate to supporting improved employee health behavior. Efforts to alter the dynamics of health plan and provider competition will likely have to come from other sources, including private employer coalitions, multistakeholder collaborative organizations, and the public sector."
(JAMA. 2007;298(19):2281-2288. 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
PEDOMETERS SHOWN TO INCREASE PHYSICAL ACTIVITY AND IMPROVE HEALTH
INTRO:
People seeking the motivation to get up and get moving may want to consider using a pedometer. A new study says these small devices can help increase physical activity and improve health. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
NAT SOT UP FULL FOR : 09
Dr. Bravata demonstrating pedometer use
AUDIO:
"A pedometer is a small, relatively inexpensive device that’s typically worn at the hip that measures the number of steps that someone walks in a day."
VIDEO:
B-ROLL
Wide of Dr. Bravata with pedometer
C/u pedometer
Dr. Bravata and colleagues at desk reviewing data
GFX/JAMA COVER
AUDIO:
DR. DENA BRAVATA (bra-VAH-ta) OF STANFORD UNIVERSITY WANTED TO KNOW IF PEDOMETERS COULD HELP MOTIVATE HER SEDENTARY PATIENTS TO GET MOVING. SO SHE AND HER COLLEAGUES REVIEWED PEDOMETER-USE STUDIES THAT INCLUDED DATA FROM MORE THAN TWENTY-SEVEN-HUNDRED PEOPLE. THEIR FINDINGS APPEAR IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
@ :26
Super: Dena Bravata, M.D., M.S.
Stanford University School of Medicine
Runs :12
AUDIO:
"Pedometer users increase their physical activity. They increased their physical activity by about 2,000 steps per day, which is equal to about a mile per day or 100 calories per day."
VIDEO:
B-ROLL
Calla walking outside
AUDIO:
A TYPICAL GOAL FOR PEDOMETER USERS IS TEN-THOUSAND STEPS A DAY, BUT IT’S HAVING A GOAL THAT MATTERS.
VIDEO:
SOT/FULL
Dena Bravata, M.D., M.S.
Stanford University School of Medicine
Runs :09
AUDIO:
"We found that having any goal, either 10,000 steps per day or an individualized goal, was associated with improvements in physical activity."
VIDEO:
B-ROLL
Close up pedometer
Dr. Bravata and Calla looking at step diary
Close up diary
AUDIO:
PEOPLE IN THE STUDY WHO USED PEDOMETERS AND HAD STEP GOALS LOWERED THEIR BODY MASS INDEX AND/OR THEIR BLOOD PRESSURE. BUT THERE WAS ANOTHER TOOL THEY USED TO HELP THEM… A STEP DIARY, TO RECORD THEIR STEPS EACH NIGHT.
VIDEO:
SOT/FULL
Dena Bravata, M.D., M.S.
Stanford University School of Medicine
Runs :06
AUDIO:
"We found that the use of a diary was an important part of increasing physical activity among pedometer users."
VIDEO:
B-ROLL
Sequence of Calla putting on pedometer
AUDIO:
CALLA FLEISHER HAS USED A PEDOMETER, A DAILY 10-THOUSAND STEP GOAL AND STEP DIARY NEARLY EVERY DAY SINCE 2005.
VIDEO:
SOT/FULL
@ 1:20
Super: Calla Fleisher
Uses pedometer
Runs :11
AUDIO:
"I’m definitely fitter and my blood pressure is down, all my blood results are better, my fitness is 100 times better and I’ve lost 45 pounds."
VIDEO:
B-ROLL
Calla walking outside
AUDIO:
SHE SAYS SHE HAS ALSO IMPROVED HER DIET, BUT IT’S THE PEDOMETER THAT HAS INSPIRED HER.
VIDEO:
SOT/FULL
Calla Fleisher
Uses pedometer
Runs :09
AUDIO:
"The pedometer really acts as a friend that you’re kind of having this conversation with everyday, you know, how well did I do, oh I’ve got to do a little better tomorrow."
VIDEO:
B-ROLL
C/u pedometer on Calla’s waistband outdoors
AUDIO:
AND IN HER CASE IT ALSO TELLS HER, "GOOD JOB." THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
Dr. Bravata says you can purchase a pedometer for under twenty dollars, and she strongly recommends getting one with a cover so you don’t accidentally erase your step count during the day. For more information, visit www.jama.com.
