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 of 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 CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 14, 2008)
MINOR LEG INJURIES ASSOCIATED WITH RISK OF BLOOD CLOTS
VITAMIN D2 SUPPLEMENTS MAY HELP PREVENT FALLS AMONG HIGH-RISK OLDER WOMEN
LOW TESTOSTERONE LEVELS ASSOCIATED WITH RISK OF FRACTURE IN MEN OVER 60
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 14, 2008)
GENETIC DIFFERENCES MAY HELP EXPLAIN RESPONSE TO MULTIPLE SCLEROSIS TREATMENT
UNDERNOURISHED STROKE PATIENTS MAY HAVE MORE COMPLICATIONS, WORSE OUTCOMES
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 14, 2008)
DIETS HIGH IN LUTEIN, ZEAXANTHIN AND VITAMIN E ASSOCIATED WITH DECREASED RISK OF CATARACTS
SMOKING RELATED TO LONG-TERM RISK AND PROGRESSION OF AGE-RELATED EYE DISEASE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 14, 2008
Media Advisory: To contact corresponding author Frits R. Rosendaal, M.D., Ph.D., e-mail F.R.Rosendaal{at}LUMC.nl.
MINOR LEG INJURIES ASSOCIATED WITH RISK OF BLOOD CLOTS
CHICAGO—Muscle ruptures, ankle sprains and other common minor leg injuries appear to be associated with a higher risk for blood clots in the legs or lungs, according to a report in the January 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous studies have shown that major injuries increase the risk for venous thrombosis, according to background information in the article. This disorder includes deep vein thrombosis, or blood clots in the leg, and pulmonary embolism, or a blood clot that has traveled to the lungs,. "However, apart from the injury itself, other risk factors for venous thrombosis will be present because of the major injury, such as surgery, a plaster cast, hospitalization and extended bed rest," the authors write. "The risk of so-called minor injuries that do not lead to these additional factors is unknown."
Karlijn J. van Stralen, M.Sc., and colleagues at Leiden University Medical Center, Leiden, the Netherlands, studied 2,471 patients who developed venous thrombosis between 1999 and 2004. The patients completed a questionnaire about any injuries, surgical procedures, plaster casts or immobilizations they had within one year of developing blood clots, as well as their height, weight, family history and sports participation. These patients were compared with 3,534 controls who did not have venous thrombosis, recruited by inviting partners of the patients to participate as well as using a random-digit–dialing method.
A total of 289 patients (11.7 percent) had a minor injury in the three months prior to developing venous thrombosis, while 154 controls (4.4 percent) had a minor injury in the three months before completing the questionnaire. "Minor injuries that do not require surgery, a plaster cast or extended bed rest were associated with a three-fold greater relative risk of venous thrombosis," the authors write. "The association appeared local because injuries in the leg were associated strongly with thrombosis, while injuries in other locations were not associated with thrombosis. The association was strongest for injuries that occurred in the month before the venous thrombosis, suggesting a transient effect." The association was also stronger in individuals with genetic or other risk factors for blood clots.
There are several reasons such injuries may increase the risk of blood clots, the authors note. Even injuries that do not require an individual to be completely immobilized may cause them to be less active, potentially leading to blood clots. In addition, damage to the blood vessel wall from an injury also could increase clotting risk in the affected area.
"Because minor injuries are common, they can be major contributors to the occurrence of venous thrombosis," the authors conclude. "Many individuals with minor injuries will have contacted the general practitioner first. Therefore, there may be an important task for general practitioners to identify subjects who are at high risk of developing venous thrombosis and subsequently to provide prophylactic measures."
(Arch Intern Med. 2008;168[1]:21-26. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Netherlands Heart Foundation, a grant from the Dutch Cancer Foundation and a grant from the Netherlands Organisation for Scientific Research. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 14, 2008
Media Advisory: To contact Richard L. Prince, M.D., e-mail rlprince{at}cyllene.uwa.edu.au.
VITAMIN D2 SUPPLEMENTS MAY HELP PREVENT FALLS AMONG HIGH-RISK OLDER WOMEN
CHICAGO—Vitamin D2 supplements appear to reduce the risk of falls among women with a history of falling and low blood vitamin D levels living in sunny climates, especially during the winter, according to a report in the January 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"Approximately one-third of women older than 65 years fall each year, and 6 percent sustain a fracture as a result of the fall," the authors write as background information in the article. "In addition, fear of falling is a major problem in older people."
Richard L. Prince, M.D., of the Sir Charles Gairdner Hospital, Nedlands, Australia, and colleagues conducted a year-long clinical trial of 302 women age 70 to 90 years living in Perth, Australia. Because vitamin D is produced in response to sun exposure and the study was completed in a sunny climate, the researchers selected women with blood vitamin D levels below the median for the area (24 nanograms per milliliter). All participants had a history of falling in the previous year and received 1,000 milligrams of calcium citrate per day. Half were then randomly assigned to take either 1,000 international units of vitamin D2 (ergocalciferol) and half took an identical placebo. Data on falls were collected from participants every six weeks.
Eighty women (53 percent) in the vitamin D2 group and 95 women (62.9 percent) in the control group fell at least once during the study period. After adjusting for height, which affected the risk of falling and was significantly different between the two groups, vitamin D2 therapy reduced the risk of having at least one fall by 19 percent. "When those who fell were grouped by the season of first fall or the number of falls they had, ergocalciferol treatment reduced the risk of having the first fall in winter and spring but not in summer and autumn, and reduced the risk of having one fall but not multiple falls," the authors write.
"It is interesting that the ergocalciferol therapy effect was confined to those who were to sustain one fall but not those destined to have more than one fall," the authors write. "Older people who fall frequently tend to have more risk factors for falling, including greater degrees of disability and poorer levels of physical function." It is possible that chemically correcting vitamin D levels in the blood is insufficient to prevent falls in these individuals, they note. "Ergocalciferol, 1,000 international units per day, added to a high calcium intake is associated with 23 percent reduction of the risk of falling in winter/spring to the same level as in summer/autumn," the authors conclude.
(Arch Intern Med. 2008;168[1]:103-108. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a research grant from the National Health and Medical Research Council of Australia. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 14, 2008
Media Advisory: To contact Christian Meier, M.D., e-mail christian.meier{at}unibas.ch.
LOW TESTOSTERONE LEVELS ASSOCIATED WITH RISK OF FRACTURE IN MEN OVER 60
CHICAGO—Men over age 60 who have low blood testosterone levels may be at a higher risk for fractures, according to a report in the January 14 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
One-third of all osteoporotic fractures caused by porous bones occur in men, according to background information in the article. Men with a previous osteoporotic fracture have three to four times the risk of having another fracture than a woman of the same age with a fracture. "Preventing the first such fracture may have major public health implications," the authors note. "Thus, understanding the determinants of fracture risk in men may reduce the burden of disease through facilitating better prevention strategies."
Christian Meier, M.D., of the University of Sydney, Concord, New South Wales, Australia, and colleagues observed 609 men (average age 72.6) between January 1989 and December 2005. The men’s bone mineral density and lifestyle factors were recorded at the beginning of the study. Serum testosterone and estradiol (an estrogen) levels were measured and the occurrence of a low-trauma fracture (associated with a fall from standing height or less) was determined during follow-up.
Low-trauma fractures occurred in 113 men during follow-up with the risk of fracture significantly higher in those with low testosterone levels. "Twenty-five men experienced multiple incident fractures," the authors note. "A total of 149 incident fractures were reported, including 55 vertebral, 27 hip, 28 rib, six wrist and 16 upper and 17 lower extremity fractures."
"After adjustment for sex hormone-binding globulin (a blood protein), serum testosterone and serum estradiol levels were associated with overall fracture risk," according to the authors. "After further adjustment for major risk factors of fractures (age, weight or bone mineral density, fracture history, smoking status, calcium intake and sex hormone-binding globulin), lower testosterone was still associated with increased risk of fracture, particularly with hip and non-vertebral fractures."
Although low levels of estradiol and testosterone were associated with a higher risk of fracture in men over 60, only the effect of testosterone was independent of other risk factors, the authors conclude. "While testosterone may affect fracture risk via skeletal and non-skeletal mechanisms, the present findings suggest that measurement of serum testosterone provides additional clinical information for the assessment of fracture risk in elderly men."
(Arch Intern Med. 2008;168[1]:47-54. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the National Health and Medical Research Council of Australia; and the ARUP Institute for Clinical and Experimental Pathology. Dr. Meier is the recipient of a medical research fellowship from the Swiss National Science Foundation and a research fellowship from the Margarete und Walter Lichtenstein Stiftung der Universität Basel. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 14, 2008
Media Advisory: To contact corresponding author Jorge R. Oksenberg, Ph.D., call Jennifer O'Brien at 415-476-8432.
GENETIC DIFFERENCES MAY HELP EXPLAIN RESPONSE TO MULTIPLE SCLEROSIS TREATMENT
CHICAGO—By comparing the DNA of patients with multiple sclerosis whose symptoms are reduced by interferon beta therapy to the DNA of those who continue to experience relapses, researchers may have identified important genetic differences between the two, according to an article posted online today that will appear in the March 2008 print issue of Archives of Neurology, one of the JAMA/Archives journals. These differences could eventually be used to help predict which treatments will help which patients.
Multiple sclerosis (MS) is a neurological disorder in which nerve fiber coatings degenerate, causing muscle weakness, spasms and partial or complete paralysis. A protein known as recombinant interferon beta is widely used to treat multiple sclerosis symptoms and possibly slow progression of the disease, according to background information in the article. "Despite interferon beta therapy, up to 50 percent of patients with MS continue to experience relapses and worsening disability," the authors write. "In addition, adverse effects, such as flulike symptoms and depression, are common, leading many patients to discontinue therapy."
Esther Byun, M.D., of the University of California, San Francisco, and colleagues of a multi-center international collaboration followed a group of 206 Southern European patients with relapsing-remitting MS—the most common type, in which patients experience periods of symptoms followed by periods of symptom-free remission—for two years after they began interferon beta therapy. Every three months, neurologists analyzed patients’ disability levels; throughout the study, 99 responded positively to interferon beta and 107 did not.
The researchers pooled the DNA of individuals in each group and used microarrays to identify, across the genome, genetic markers associated with the response to interferon beta. They identified the top 35 single nucleotide polymorphisms (SNPs), changes in a single base of DNA, that were candidates for further analysis. They then located these SNPs in each individual participant to see if the mutations apparent in responders differed from those in non-responders. After this analysis was complete, an additional 81 individuals with MS (44 responders and 35 non-responders) were included and the DNA of responders was again compared to that of non-responders.
Of the 35 candidate SNPs identified in the first screen, 18 were found to remain significantly associated with treatment response in the combined screen. Seven of the SNPs were located within genes, while the others were located in the space between genes. Some of the SNPs were located in genes previously linked to processes involved with MS, such as the growth and repair of nerve cells.
"The beneficial outcomes of interferon beta therapy for patients in the relapsing-remitting phase of MS have been clearly shown," the authors write. "On the other hand, the effect of this treatment is partial, and a substantial amount of patients are not responders. Hence, in the absence of prognostic clinical, neuroradiological and/or immunological markers of response, the question remains who and when to treat when adverse effects, inconvenience and the cost of the drug are significant."
The identification of genetic mutations that affect response to interferon provides important new information about how the drug functions in the body, bringing medicine one step closer to rational drug design and personalized medicine, the authors note. However, additional research will be needed to fully predict treatment outcomes based on DNA analysis.
(Arch Neurol. 2008;65[3]:[doi:10.1001/archneurol.2008.47].
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was funded by a National Institutes of Health grant. Dr. Byun was supported in part by the University of California, San Francisco, School of Medicine Genentech Foundation Fellowship. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Media Advisory: To contact corresponding author Dong-Wha Kang, M.D., Ph.D., e-mail dwkang{at}amc.seoul.kr. To contact corresponding editorialist Mitchell S.V. Elkind, M.D., M.S., call Elizabeth Streich at 212-305-6535.
UNDERNOURISHED STROKE PATIENTS MAY HAVE MORE COMPLICATIONS, WORSE OUTCOMES
CHICAGO—Patients who are undernourished when they enter the hospital with an acute ischemic stroke—the most common type of stroke, in which blood flow to the brain is blocked—are likely to remain undernourished in the hospital and may have worse clinical outcomes, according to a report in the January issue of Archives of Neurology, one of the JAMA/Archives journals.
"Although undernutrition [a deficiency in overall calories or one or more nutrients] is common in medical, geriatric and stroke patients, its treatment has received little attention," the authors write as background information in the article. "Because undernutrition may influence clinical outcomes, it is important to assess nutritional status and treat undernutrition particularly during acute stage of stroke."
Sung-Hee Yoo, R.N., M.S., and colleagues at the University of Ulsan College of Medicine, Seoul, Korea, studied 131 acute ischemic stroke patients who underwent assessments of their nutritional status within 24 hours of hospital admission and again one week after their symptoms began. Complications were assessed immediately after admission to the hospital and continuously until patients left the hospital or transferred to a rehabilitation unit. Clinical outcomes were measured three months later.
Of the patients, 16 (12.2 percent) were insufficiently nourished when they were admitted to the hospital and 26 (19.8 percent) were undernourished after one week. Undernutrition at hospital admission was associated with undernutrition one week later and complications following the stroke, while undernutrition at one week predicted poor outcomes after three months.
"These results suggest that patients undernourished at admission do not recover well with general hospital diets and are more likely to have poststroke complications and that undernourished patients during hospitalization are more likely to develop poor functional outcomes," the authors write.
"Strategic nutritional support, particularly in patients with baseline undernutrition, may improve clinical outcomes after acute ischemic stroke," they conclude.
(Arch Neurol. 2008;65[1]:39-43.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the Korean Ministry of Health and Welfare, a grant from the Korea Health 21 R&D Project, Ministry of Health and Welfare, Republic of Korea, and a grant from the Brain Research Center of the 21st Century Frontier Research Program funded by the Ministry of Science and Technology of Korea. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: NUTRITIONAL SUPPORT COULD IMPROVE RECOVERY FOLLOWING STROKE
"The undernourished state may represent another modifiable physiological risk factor, like hyperglycemia and fever, that when actively treated leads to improved outcomes," write Neeraj Badjatia, M.D., and Mitchell S. V. Elkind, M.D., M.S., of the Columbia University Medical Center, New York, in an accompanying editorial.
"This article is the latest in a series of studies representing current thinking about the potential value of nutritional support for stroke patients in the acute care setting," they continue. "Providing adequate caloric intake early in the course after ischemic stroke may now be seen as a therapeutic intervention used to minimize disease severity, reduce complications and favorably affect patient outcomes. In the end, factors related to overall amount, content, route and timing may determine whether nutritional support improves outcomes or is ineffective."
(Arch Neurol. 2008;65[1]:15-16.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
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Media Advisory: To contact William G. Christen, Sc.D., call Lori J. Shanks at 617-534-1604.
DIETS HIGH IN LUTEIN, ZEAXANTHIN AND VITAMIN E ASSOCIATED WITH DECREASED RISK OF CATARACTS
CHICAGO—Women who have higher dietary intakes of lutein and zeaxanthin—compounds found in yellow or dark, leafy vegetables—as well as more vitamin E from food and supplements appear to have a lower risk for developing cataracts, according to a report in the January issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
"The oxidative hypothesis of cataract formation posits that reactive oxygen species can damage lens proteins and fiber cell membranes and that nutrients with antioxidant capabilities can protect against these changes," the authors write as background information in the article. Vitamin E, vitamin C, beta carotene, lutein and zeaxanthin are all believed to have antioxidant properties. Lutein and zeaxanthin are the only carotenoids—yellow plant pigments—present in the lens of the human eye and may also protect against cataracts by filtering harmful blue light.
William G. Christen, Sc.D., of Brigham & Women’s Hospital and Harvard Medical School, Boston, and colleagues analyzed dietary information from 35,551 female health professionals who enrolled in the Women’s Health Study in 1993. The women were then followed for an average of 10 years, and the diets of those who developed cataracts were compared with the diets of those who did not.
A total of 2,031 women developed cataracts during the study. When the participants were split into five groups based on the amount of lutein and zeaxanthin they consumed, those in the group who consumed the most (about 6,716 micrograms per day) had an 18 percent lower chance of developing cataracts than those who consumed the least (1,177 micrograms per day). The one-fifth who consumed the most vitamin E from food and supplements—about 262.4 milligrams per day—were 14 percent less likely than the one-fifth who got the least (4.4 milligrams per day).
"In conclusion, these prospective data from a large cohort of female health professionals indicate that higher intakes of lutein/zeaxanthin and vitamin E are associated with decreased risk of cataract," the authors write. "Although reliable data from randomized trials are accumulating for vitamin E and other antioxidant vitamins, randomized trial data for lutein/zeaxanthin are lacking. Such information will help to clarify the benefits of supplemental use of lutein/zeaxanthin and provide the most reliable evidence on which to base public health recommendations for cataract prevention by vitamin supplementation."
(Arch Ophthalmol. 2008;126[1]:102-109. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by research grants from the National Institutes of Health and by DSM Nutritional Products, Inc. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 14, 2008
Media Advisory: To contact Ronald Klein, M.D., M.P.H., call Aaron Conklin at 608-263-5561.
SMOKING RELATED TO LONG-TERM RISK AND PROGRESSION OF AGE-RELATED EYE DISEASE
CHICAGO—Smokers appear to have an increased long-term risk and greater progression of the eye disease age-related macular degeneration, according to a report in the January issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Smoking had already been identified as one of the few modifiable risk factors for age-related macular degeneration (AMD), a leading cause of vision loss in older Americans, according to background information in the article. Smoking may contribute to AMD through several pathways, including by reducing antioxidant levels, decreasing blood flow around the eye or affecting the pigments (coloration) in the retina.
Ronald Klein, M.D., M.P.H., and colleagues at the University of Wisconsin School of Medicine and Public Health, Madison, studied 4,926 residents of Beaver Dam, Wis., who were ages 43 to 84 years in 1987 to 1988. The participants were initially examined in 1988 to 1990 and then were re-examined every five years for the next 15 years. The presence and status of AMD was measured with photographs of the retina.
At the beginning of the study, 21 percent of the men and 18 percent of the women were smokers. Smokers had a 47 percent increase in their odds of developing early AMD, which is the least severe form of the disease. They also developed AMD at a younger age (69.2 years) than former smokers (72.3 years) and those who had never smoked (74.4 years). Smoking at the beginning of the study was also associated with the cumulative progression of AMD over the 15 years of the study. "There were few associations of specific characteristics of smoking (e.g., intensity, pack-years smoked, duration and age at initiation and quitting) with AMD outcomes," the authors write.
"In summary, while controlling for other factors, smoking appears to be related to the incidence and progression of AMD in our population," they conclude. "This has important health care implications, because early AMD is associated with an increase in the risk of developing late AMD and smoking behavior is modifiable."
(Arch Ophthalmol. 2008;126[1]:115-121. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by a grant from the National Eye Institute and by a grant from the National Institute of Aging and was also supported in part by Research to Prevent Blindness, New York, N.Y. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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