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, December 4, 2007)
JAMA NEWS RELEASES
SOME COMMON TREATMENTS FOR SINUS INFECTIONS MAY NOT BE EFFECTIVE
STUDY FINDS FITNESS LEVEL, NOT BODY FAT, MAY BE STRONGER PREDICTOR OF LONGEVITY FOR OLDER ADULTS
DESPITE STRONG EVIDENCE FROM RANDOMIZED TRIALS, REFUTED CLAIMS FROM OBSERVATIONAL STUDIES OFTEN PERSIST
SIMILAR OUTCOMES AFTER ONE YEAR FOR PATIENTS WITH ACUTE CORONARY SYNDROMES TREATED WITH DIFFERENT ANTICOAGULANT REGIMENS
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
FATNESS VERSUS FITNESS; CARDIOVASCULAR FITNESS MAY BE MORE IMPORTANT THAN WEIGHT IN REDUCING RISK OF DEATH IN OLDER PEOPLE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on fitness and body fat levels as predictors of longevity. The report will be fed Tuesday, December 4, 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.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 4, 2007
Media Advisory: To contact Ian G. Williamson, M.D., email: igw{at}soton.ac.uk. To contact editorial author Morten Lindbaek, M.D., email: morten.lindbak{at}medisin.uio.no.
SOME COMMON TREATMENTS FOR SINUS INFECTIONS MAY NOT BE EFFECTIVE
CHICAGO—A comparison of common treatments for acute sinusitis that included an antibiotic and a topical steroid found neither more effective than placebo, according to a study in the December 5 issue of JAMA.
Acute sinusitis (sinus infection) is a common clinical problem with symptoms similar to other illnesses, and is often diagnosed and treated without clinical confirmation. Despite the clinical uncertainty as to a bacterial cause, antibiotic prescribing rates remain as high as 92 percent in the United Kingdom and 85 percent to 98 percent in the United States, according to background information in the article. “Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring,” the authors write. Concerns about wide-spread antibacterial use include increasing antibiotic resistance in the community. Anti-inflammatory drugs such as topical steroids are also used as a treatment and may be beneficial, but there has been limited research.
Ian G. Williamson, M.D., of the University of Southampton, England, and colleagues conducted a double-blind randomized placebo-controlled trial to determine the effectiveness of the antibiotic amoxicillin and topical steroid budesonide in acute maxillary sinusitis (rhinosinusitis; inflammation of the nasal cavity and sinuses). The study included 240 adults with acute nonrecurrent sinusitis treated at 58 family practices between November 2001 and November 2005. Patients were randomized to 1 of 4 treatment groups: antibiotic and nasal steroid (500 mg of amoxicillin 3 times per day for 7 days and 200 µg of budesonide in each nostril once per day for 10 days); placebo antibiotic and nasal steroid; antibiotic and placebo nasal steroid; placebo antibiotic and placebo nasal steroid.
The researchers found that the proportions of patients with symptoms lasting 10 or more days were 29 of 100 (29 percent) for amoxicillin vs. 36 of 107 (33.6 percent) for no amoxicillin; and 32 of 102 (31.4 percent) for topical budesonide vs. 33 of 105 (31.4 percent) for no budesonide. Secondary analysis suggested that nasal steroids were significantly more effective in patients with less severe symptoms at baseline.
“Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition. Topical steroids are likely to be effective in those with such features but who have less severe symptoms at presentation to the physician,” the authors write.
(JAMA. 2007;298(21):2487-2496. 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: ACUTE SINUSITIS — TO TREAT OR NOT TO TREAT?
In an accompanying editorial, Morten Lindbaek, M.D., of the University of Oslo, Norway, comments on the findings regarding treating acute sinusitis.
“The study by Williamson et al has implications for clinicians who treat patients with acute sinusitis–like symptoms. This study reinforces the lack of benefit from antibiotics shown in a number of other studies that recruited patients based on clinical symptoms and findings. Most patients with acute purulent sinusitis recover without antibiotic treatment, as was also observed in a study that used sinus computed tomography scans as the diagnostic standard. But some patients with sinusitis are more ill than others with fever, malaise, and deteriorated general condition. These patients still are in need of antibiotics, although they are relatively uncommon in general practice. So far there is no reliable way to distinguish viral sinusitis from bacterial sinusitis in the general practice setting, and a point of care test that could single out patients who could benefit from antibiotic treatment is not available.”
(JAMA. 2007;298(21):2543-2544. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 4, 2007
Media Advisory: To contact co-author Steven N. Blair, P.E.D., call Karen Petit at 803-777-1421.
STUDY FINDS FITNESS LEVEL, NOT BODY FAT, MAY BE STRONGER PREDICTOR OF LONGEVITY FOR OLDER ADULTS
CHICAGO—Adults over age 60 who had higher levels of cardiorespiratory fitness lived longer than unfit adults, independent of their levels of body fat, according to a study in the December 5 issue of JAMA.
Previous studies have provided evidence that obesity and physical inactivity each can produce a higher risk of death in middle-aged adults. Whether this is also true for older adults is uncertain, according to background information in the article.
Xuemei Sui, M.D., of the University of South Carolina, Columbia, and colleagues examined the associations between cardiorespiratory fitness, various clinical measures of adiposity (body fat) and death in older women and men. The study included 2,603 adults age 60 years or older (average age, 64.4 years; 19.8 percent women) enrolled in the Aerobics Center Longitudinal Study who completed a baseline health examination during 1979-2001. Fitness was assessed by a treadmill exercise test and adiposity was assessed by body mass index (BMI), waist circumference, and percent body fat. Low fitness was defined as the lowest fifth of the sex-specific distribution of treadmill exercise test duration. There were 450 deaths during an average follow-up of 12 years.
The researchers found that those who died were older, had lower fitness levels, and had more cardiovascular risk factors than survivors. However, there were no significant differences in adiposity measures. Participants in the higher fitness groups were for the most part less likely to have risk factors for cardiovascular disease, such as hypertension, diabetes, or high cholesterol levels. Fit participants had lower death rates than unfit participants within each stratum of adiposity, except for two of the obesity groups. In most instances, death rates for those with higher fitness were less than half of rates for those who were unfit.
Higher levels of fitness were inversely related to all-cause death in both normal-weight and overweight BMI subgroups, in those with a normal waist circumference and in those with abdominal obesity, and in those who have normal percent body fat and those who have excessive percent body fat.
“...we observed that fit individuals who were obese (such as those with BMI of 30.0-34.9, abdominal obesity, or excessive percent body fat) had a lower risk of all-cause mortality than did unfit, normal-weight, or lean individuals. Our data therefore suggest that fitness levels in older individuals influence the association of obesity to mortality,” the authors write.
“Our data provide further evidence regarding the complex long-term relationship among fitness, body size, and survival. It may be possible to reduce all-cause death rates among older adults, including those who are obese, by promoting regular physical activity, such as brisk walking for 30 minutes or more on most days of the week (about 8 kcal/kg per week), which will keep most individuals out of the low-fitness category. Enhancing functional capacity also should allow older adults to achieve a healthy lifestyle and to enjoy longer life in better health.”
(JAMA. 2007;298(21):2507-2516. 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 4, 2007
Media Advisory: To contact corresponding author John P. A. Ioannidis, M.D., email: jioannid{at}cc.uoi.gr.
DESPITE STRONG EVIDENCE FROM RANDOMIZED TRIALS, REFUTED CLAIMS FROM OBSERVATIONAL STUDIES OFTEN PERSIST
CHICAGO—Prominent claims from observational studies of the cardiovascular benefits of vitamin E often continue to be supported in medical literature despite strong contradictory evidence from randomized trials, according to a study in the December 5 issue of JAMA. Similar findings were found for claims regarding the protective effects of beta-carotene on cancer and estrogen on Alzheimer disease.
“Some research findings that have received wide attention in the scientific community, as proven by the high citation counts of the respective articles, are eventually contradicted by subsequent evidence. A number of such high-profile contradictions pertain to differences between nonrandomized and randomized studies,” the authors write. Despite these contradictions, findings from observational trials may still be supported in some scientific circles.
Athina Tatsioni, M.D., of the University of Ioannina School of Medicine, Ioannina, Greece, and colleagues evaluated the change in favorable vs. unfavorable citations for two highly cited epidemiological studies that proposed major cardiovascular benefits associated with vitamin E in 1993, which were strongly contradicted by evidence from large randomized clinical trials (RCTs). To assess the generalizability of these findings, the researchers also examined the extent to which two other major contradicted claims, the effectiveness of beta-carotene for preventing cancer and of estrogens for preventing Alzheimer dementia, continue to be supported in the current medical literature.
For the vitamin E claims, the researchers sampled articles published in 1997, 2001, and 2005 (before, early, and late after publication of refuting evidence) that referenced the highly cited epidemiological studies and separately sampled articles published in 2005 and referencing the major contradicting RCT (HOPE trial). They also sampled articles published in 2006 that referenced highly cited articles proposing benefits associated with beta-carotene for cancer (published in 1981 and contradicted by RCTs in 1994-1996) and estrogen for Alzheimer disease (published in 1996 and contradicted by RCTs in 2004).
The researchers found that for the two vitamin E epidemiological studies, even in 2005, 50 percent of citing articles remained favorable. A favorable stance was independently less likely in more recent articles, specifically in articles that also cited the HOPE trial and in general/internal medicine vs. specialty journals. In a sample of 29 articles published in 2005 that had cited the HOPE study, six (20.7 percent) were still favorable to vitamin E, 11 (37.9 percent) were equivocal (uncertain), and 12 (41.4 percent) were unfavorable. “Even among articles that cited the contradicting HOPE trial rather than the positive epidemiological studies, the majority in 2005 still could not conclude that vitamin E was ineffective,” the authors write.
Regarding the claims for beta-carotene, 10 citing articles (62.5 percent) were favorable, three (18.8 percent) equivocal, and three (18.8 percent) unfavorable. For estrogen, 29 citing articles (61.7 percent) were favorable, 14 (29.8 percent) equivocal, and 4 (8.5 percent) unfavorable. All beta-carotene citations and all but two estrogen citations appeared in specialty journals.
“Counterarguments defending vitamin E or estrogen included diverse selection and information biases and genuine differences across studies in participants, interventions, co-interventions, and outcomes. Favorable citations to beta-carotene, long after evidence contradicted its effectiveness, did not consider the contradicting evidence.”
“...it can be difficult to discern whether perpetuated beliefs are based on careful consideration of all evidence and differential interpretation, inappropriate entrenchment of old information, lack of dissemination of newer data, or purposeful silencing of their existence. Regardless of the reasons, better communication between research specialists and evidence-based clinical science may improve this situation and may lead to more rational and concerted translational efforts in basic, pre-clinical, and clinical research,” the researchers conclude.
(JAMA. 2007;298(21):2517-2526. 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.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, December 4, 2007
Media Advisory: To contact Gregg W. Stone, M.D., call Alex Lyda at 212-305-0820.
SIMILAR OUTCOMES AFTER ONE YEAR FOR PATIENTS WITH ACUTE CORONARY SYNDROMES TREATED WITH DIFFERENT ANTICOAGULANT REGIMENS
CHICAGO—Patients with acute coronary syndromes such as unstable angina who were undergoing an invasive treatment and received one of three anticoagulant regimens did not have significant differences in the rates of ischemia or death after one year, according to a study in the December 5 issue of JAMA.
“Early angiography followed by interventional or surgical revascularization when appropriate has been shown to result in reduced rates of death, myocardial infarction (MI), refractory ischemia, and rehospitalization in patients with acute coronary syndromes (ACS; unstable angina or non–ST-segment elevation MI [a certain pattern on an electrocardiogram following a heart attack]). Because both MI and hemorrhagic complications have been associated with early and late mortality in patients with ACS and in those undergoing percutaneous coronary intervention (PCI), the optimal [added] pharmacological regimen to support the invasive approach in ACS would ideally suppress adverse ischemic and thrombotic events while minimizing iatrogenic [induced by treatment] bleeding,” the authors write.
In the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial, randomization of moderate-risk and high-risk patients with ACS undergoing early invasive management to monotherapy with the direct thrombin (blood-clotting enzyme) inhibitor bivalirudin compared with a heparin-based regimen plus glycoprotein (GP) IIb/IIIa inhibitors resulted in noninferior 30-day rates of adverse ischemic events with reduced rates of major bleeding. The long-term effect of bivalirudin monotherapy and a selective GP IIb/IIIa inhibitor strategy on composite ischemia and death are unknown.
Gregg W. Stone, M.D., of Columbia University Medical Center and the Cardiovascular Research Foundation, New York, and colleagues examined the 1-year clinical outcomes of patients enrolled in the ACUITY trial. The randomized, open-label trial was conducted at 450 academic and community-based institutions in 17 countries. A total of 13,819 patients with moderate- and high-risk ACS undergoing invasive treatment were enrolled between August 2003 and December 2005. Patients were assigned to heparin plus GP IIb/IIIa inhibitors (n = 4,603), bivalirudin plus GP IIb/IIIa inhibitors (n = 4,604), or bivalirudin monotherapy (n = 4,612). Of these patients, 4,605 were assigned to routine upstream (prior to angiography) GP IIb/IIIa use and 4,602 were deferred to selective GP IIb/IIIa use.
Compared with the control group of heparin plus GP IIb/IIIa inhibitors in which the 1-year estimated rate of composite ischemia was 15.4 percent, composite ischemia occurred in 16.0 percent of patients assigned to bivalirudin plus GP IIb/IIIa inhibitors and in 16.2 percent of patients assigned to bivalirudin monotherapy. Death at 1 year occurred in an estimated 3.9 percent of patients assigned to heparin plus GP IIb/IIIa inhibitors, 3.9 percent assigned to bivalirudin plus GP IIb/IIIa inhibitors, and 3.8 percent assigned to bivalirudin monotherapy. There were no significant differences in the rates of the individual components of death, MI, or unplanned revascularization for ischemia between the three groups.
“At 1 year, no statistically significant difference in rates of composite ischemia or mortality among patients with moderate- and high-risk ACS undergoing invasive treatment with the 3 therapies was found,” the authors conclude. “There was no statistically significant difference in the rates of composite ischemia between patients receiving routine upstream administration of GP IIb/IIIa inhibitors vs. deferring their use for patients undergoing PCI.”
(JAMA. 2007;298(21):2497-2506. 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.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
FATNESS VERSUS FITNESS; CARDIOVASCULAR FITNESS MAY BE MORE IMPORTANT THAN WEIGHT IN REDUCING RISK OF DEATH IN OLDER PEOPLE
INTRO:
Many of us may overindulge when it comes to food this holiday season. But a new study says that while maintaining a healthy weight is important, it’s regular physical activity that could actually help people over sixty live longer. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Bob on treadmill
Cutaway feet
AUDIO:
SIXTY-SEVEN YEAR OLD BOB MARKLAND HAS EXERCISED REGULARLY FOR YEARS.
VIDEO:
SOT/FULL
@ :06
Super: Bob Markland
Exercises regularly
Runs :06
AUDIO:
“I think it’s very important for older people in terms of keeping their weight down.”
VIDEO:
B-ROLL
Bob and Warren walking together outside
AUDIO:
BUT KEEPING WEIGHT DOWN IS NOT THE ONLY REASON FOR OLDER PEOPLE TO STAY PHYSICALLY ACTIVE.
VIDEO:
SOT/FULL
@ :16
Super: Steven Blair, P.E.D.
University of South Carolina
Runs :10
AUDIO:
“Even in individuals who were fat, indeed even in people who were obese, if they were fit, they did not have higher risk of dying.”
VIDEO:
SOT/FULL
John Robbins, M.D.
University of California Davis
Runs :08
AUDIO:
“Clearly, the major factor is age, and that the older you get the more likely you are to have a fracture.”
VIDEO:
B-ROLL
Let bite run through name
Older people walking in mall
GFX/JAMA COVER
Heavier couple walking
Other people walking
AUDIO:
DR. STEVEN BLAIR OF UNIVERSITY OF SOUTH CAROLINA WAS AMONG THE RESEARCHERS WHO STUDIED FATNESS, FITNESS AND DEATH RATES IN ABOUT 26-HUNDRED PEOPLE AGE SIXTY AND OLDER. THEIR STUDY, IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, FINDS THAT WHEN IT COMES TO PREDICTING MORTALITY, CARDIOVASCULAR FITNESS APPEARS MORE IMPORTANT THAN WHETHER ONE IS FAT OR NOT.
VIDEO:
SOT/FULL
Steven Blair, P.E.D.
University of South Carolina
Runs :05
AUDIO:
“You ask how? How can a person be fat and fit? Well, you have to exercise.”
VIDEO:
B-ROLL
More older people walking in mall
Heavier person walking
AUDIO:
BY EXERCISE, DR. BLAIR MEANS THIRTY MINUTES OF BRISK WALKING FIVE DAYS A WEEK. IF YOU CAN DO THAT, YOU’RE CONSIDERED FIT, WHATEVER YOUR WEIGHT.
VIDEO:
SOT/FULL
Steven Blair, P.E.D.
University of South Carolina
Runs :07
AUDIO:
“In fact, even if you’re obese and fit your death rate is no different than the normal weight person who is fit.”
VIDEO:
B-ROLL
Obese people
Obese man
Obese woman
AUDIO:
DR. BLAIR SAYS PEOPLE WHO ARE SEVERELY OBESE DO HAVE HIGHER DEATH RATES, AS DO PEOPLE WITH HIGH WAIST CIRCUMFERENCE. ABOUT FORTY INCHES IN MEN AND ABOUT THIRTY-FIVE INCHES IN WOMEN IS CONSIDERED TOO HIGH. BUT IN GENERAL, FITNESS IS ASSOCIATED WITH A LOWER RISK OF DEATH.
VIDEO:
SOT/FULL
Steven Blair, P.E.D.
University of South Carolina
Runs :11
AUDIO:
“The least fit 20% have a death rate that is twice as high or a little more than the people who are getting that 30 minutes of walking five days a week.”
VIDEO:
B-ROLL
Bob on exercise bike
AUDIO:
AND PEOPLE WHO ARE EVEN MORE FIT HAVE AN EVEN LOWER DEATH RATE, WHICH IS WHY...
VIDEO:
SOT/FULL
Steven Blair, P.E.D.
University of South Carolina
Runs :04
AUDIO:
“As a 68-year old fat man, I’m still running 25 miles a week.”
VIDEO:
B-ROLL
Warren on treadmill
AUDIO:
WARREN HUGHES DOES MORE MODERATE EXERCISE, BUT SHE HAS BIG REASONS FOR DOING SO.
VIDEO:
SOT/FULL
@ 1:45
Super: Warren Hughes
Exercises regularly
Runs :07
AUDIO:
“I want to be able to stay active and I want to not be confined in any way and live longer.”
VIDEO:
B-ROLL
Pan from feet to face/Warren on treadmill
AUDIO:
AND STAYING FIT MAY HELP HER DO THAT. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The study determined fitness through a treadmill test, and found that twenty percent of the people in the study who were the least fit had a death rate that was four times higher than the most fit twenty percent. For more information, visit www.jama.com.
