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, May 12, 2008)
AIR POLLUTION MAY BE ASSOCIATED WITH BLOOD CLOTS IN DEEP LEG VEINS
STUDY DOCUMENTS PREVALENCE OF OBESITY AND ITS ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS AMONG SEVERAL ETHNIC GROUPS
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, May 12, 2008)
ANTI-INFLAMMATORY DRUGS DO NOT IMPROVE COGNITIVE FUNCTION IN OLDER ADULTS
ELECTRODE RE-IMPLANTATION MAY HELP PATIENTS WHO DON’T RESPOND TO BRAIN STIMULATION FOR PARKINSON’S DISEASE
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, May 12, 2008)
HIGH BLOOD PRESSURE, HIGH CHOLESTEROL MAY BE ASSOCIATED WITH RETINAL VASCULAR DISEASE
GLAUCOMA PATIENTS WITH POOR HEALTH LITERACY MAY HAVE GREATER DISEASE PROGRESSION
LOW-VISION REHABILITATION APPEARS TO IMPROVE VISUAL FUNCTION IN MACULAR DISEASE
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 12, 2008
Media Advisory: To contact Andrea Baccarelli, M.D., Ph.D., call Todd Datz at 617-432-3952. To contact editorialist Robert D. Brook, M.D., call Kara Gavin at 734-764-2220.
AIR POLLUTION MAY BE ASSOCIATED WITH BLOOD CLOTS IN DEEP LEG VEINS
CHICAGO—Long-term exposure to air pollution appears to be associated with an increased risk of deep vein thrombosis, blood clots in the thigh or legs, according to a report in the May 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Exposure to particulate air pollution—very small particles of solid and liquid chemicals that come from burning fossil fuels and other sources—has been linked to the increased risk of developing or dying from heart disease and stroke, according to background information in the article. Recent studies have suggested this relationship may result at least in part from the effects of particulate air pollution on blood clotting.
Andrea Baccarelli, M.D., Ph.D., of the Harvard School of Public Health, Boston, and colleagues assessed exposure to particulate matter smaller than 10 micrometers in diameter among 870 patients who had been diagnosed with deep vein thrombosis in Lombardy, Italy, between 1995 and 2005. These patients, along with 1,210 controls who did not have deep vein thrombosis, were assigned to one of nine geographic regions based on where they lived at the time of the study. The researchers then used the average concentration of particulate matter for each area, obtained by monitors located at 53 different sites throughout the region, to estimate the level of exposure over the year before diagnosis (for cases) or examination (for controls).
Individuals with deep vein thrombosis tended to have a higher exposure to particulate air pollution than controls. After adjusting for other environmental and health factors, for every increase in particulate matter of 10 micrograms per square meter the previous year, the risk of deep vein thrombosis increased 70 percent. In addition, the blood of patients in both the case and control groups with higher levels of exposure to particulate matter took less time to clot, as measured by a test given in the clinic.
The association between particle exposure and blood clots was stronger in men than in women, and disappeared among women taking oral contraceptives or hormone therapy. “Such hormone therapies are independent risk factors for deep vein thrombosis, which is also confirmed in this study by the higher prevalence of oral contraceptive and hormone use in the cases compared with the controls,” the authors write.
“Given the magnitude of the observed effects and the widespread diffusion of particulate pollutants, our findings introduce a novel and common risk factor into the pathogenesis of deep vein thrombosis and, at the same time, give further substance to the call for tighter standards and continued efforts aimed at reducing the impact of urban air pollutants on human health,” they conclude.
(Arch Intern Med. 2008;168[9]:920-927. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by grants from the Environmental Protection Agency Particulate Matter Center; grants from the National Institute of Environmental Health Sciences; a grant from the MIUR Internationalization Program; and grants from the CARIPLO Foundation and Lombardy region. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: BLOOD CLOT RISK COULD INCREASE ESTIMATES OF DEATH TOLL FROM POLLUTION
Air pollution “has become so omnipresent over the past century as to be commonly perceived as a normal natural entity—‘the lazy, hazy days of summer’,” writes Robert D. Brook, M.D., of the University of Michigan, Ann Arbor, in an accompanying editorial.
“While we have learned to live within this haze without a second thought, air pollution is neither natural nor benign,” he continues. “Even though the absolute cardiovascular risk posed to one individual at any single time point is small, owing to the ubiquitous and constant nature of exposure, particulate matter ranks as the 13th leading cause of global mortality (approximately 800,000 deaths annually).”
Dr. Baccarelli and colleagues have presented evidence of a new category of health risks associated with pollution, he writes. “If future studies corroborate their findings and address some of the limitations, it may be proven that the actual totality of the health burden posed by air pollution, already known to be tremendous, may be even greater than ever anticipated,” Dr. Brook concludes.
(Arch Intern Med. 2008;168[9]:909-911. 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.
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, May 12, 2008
Media Advisory: To contact Gregory L. Burke, M.D., M.S., call Shannon Koontz at 336-716-2415.
STUDY DOCUMENTS PREVALENCE OF OBESITY AND ITS ASSOCIATION WITH CARDIOVASCULAR RISK FACTORS AMONG SEVERAL ETHNIC GROUPS
CHICAGO—Obesity rates appear high in most but not all ethnic groups in the United States, and extra weight is associated with cardiovascular risk factors and markers of sub-clinical heart disease, according to a report in the May 12 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The United States, along with many other countries, is experiencing an epidemic of obesity, according to background information in the article. Between 1960 and 2000, rates of obesity increased from 11 percent to 28 percent in men and 16 percent to 34 percent in women. “The obesity epidemic has the potential to reduce further gains in the U.S. life expectancy, largely through an effect on cardiovascular disease mortality [death],” the authors write.
Gregory L. Burke, M.D., M.S., of Wake Forest University School of Medicine, Winston-Salem, N.C., and colleagues assessed data from the Multi-Ethnic Study of Atherosclerosis (MESA), which involved 6,814 individuals age 45 to 84 who did not have cardiovascular disease when the study began (2000 to 2002). Participants completed a standard questionnaire with information about demographics and health risk factors and also underwent testing for a variety of cardiovascular disease markers.
“A large proportion of white, African American and Hispanic participants were overweight (60 percent to 85 percent) and obese (30 percent to 50 percent), while fewer Chinese American participants were overweight (33 percent) or obese (5 percent),” the authors write. “A higher body mass index (BMI) was associated with more adverse levels of blood pressure, lipoproteins [cholesterol] and fasting glucose despite a higher prevalence of pharmacologic treatment.”
Obesity also was associated with the following risk factors for heart disease and stroke:
- A 17 percent greater risk of coronary artery calcium, which may be a marker of coronary artery disease
- A 45 percent greater risk of having artery walls thicker than the 80th percentile in the common carotid arteries, which is a marker for atherosclerosis
- A 2.7-fold greater risk of having a left ventricle (the lower chamber of the heart that pumps blood throughout the body) with a mass higher than the 80th percentile
“These data confirm the epidemic of obesity in most but not all racial and ethnic groups,” the authors conclude. “The observed low prevalence of obesity in Chinese American participants indicates that high rates of obesity should not be considered inevitable. These findings may be viewed as indicators of potential future increases in vascular disease burden and health care costs associated with the obesity epidemic.”
(Arch Intern Med. 2008;168[9]:928-935. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by contracts from the National Heart, Lung, and Blood Institute and by the Wake Forest University General Clinical Research Center. 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, May 12, 2008
Media Advisory: To contact corresponding author Barbara K. Martin, Ph.D., call Tim Parsons at 410-955-7619.
ANTI-INFLAMMATORY DRUGS DO NOT IMPROVE COGNITIVE FUNCTION IN OLDER ADULTS
CHICAGO—The anti-inflammatory drugs naproxen and celecoxib do not appear to improve cognitive function in older adults with a family history of Alzheimer’s disease, and naproxen may have a slightly detrimental effect, according to an article posted online today that will appear in the July 2008 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Inflammatory processes may play a role in Alzheimer’s disease and other neurodegenerative disorders, as well as in the decline of cognitive (thinking, learning and memory) function in older adults, according to background information in the article. “Consistent with this hypothesis, observational studies have shown an association between the use of non-steroidal anti-inflammatory drugs (NSAIDs) and a lower risk of Alzheimer’s disease,” the authors write.
The ADAPT (Alzheimer’s Disease Anti-Inflammatory Prevention Trial) Research Group conducted a randomized clinical trial involving 2,117 individuals age 70 and older with a family history of Alzheimer’s disease. From March 2001 to December 2004, 617 took 200 milligrams of the NSAID celecoxib twice daily, 596 took 220 milligrams of naproxen sodium twice daily and 904 took placebo. Each year, the study participants took seven tests assessing cognitive function that were added into one global summary score. Treatments were halted in December 2004 because another study found increased cardiovascular risks associated with celecoxib.
“The ADAPT cognitive function results through six months after study treatment cessation do not show a protective effect with the use of NSAIDs and may suggest that cognitive scores are lower,” the authors write. “The global summary scores, which combine the results from seven individual tests in the cognitive assessment battery, were significantly lower over time for naproxen, but not for celecoxib, compared with placebo.”
There are several explanations for the difference between these findings and those of previous observational trials, the authors note. Because observational trials do not assign participants to treatment groups but analyze existing behavior, additional factors that were not measured may have confounded or affected the results. In addition, the findings of this trial may apply only to celecoxib and naproxen and not to other anti-inflammatories, such as ibuprofen. Finally, NSAIDs may be protective only when given several years before the time when cognitive function would have begun to decline.
“Continued follow-up of trial participants, even after cessation of treatment, appears warranted to investigate treatment effects with respect to the timing of exposure,” the authors write. “However, for now we suggest that naproxen and celecoxib should not be used for the prevention of Alzheimer’s disease.”
(Arch Neurol. 2008;65[7]:(doi:10.1001/archneur.2008.65.7.nct70006. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the National Institute on Aging. 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, May 12, 2008
Media Advisory: To contact Mathieu Anheim, M.D., e-mail anheim{at}titus.u-strasbg.fr.
ELECTRODE RE-IMPLANTATION MAY HELP PATIENTS WHO DON’T RESPOND TO BRAIN STIMULATION FOR PARKINSON’S DISEASE
CHICAGO—A study of seven patients with Parkinson’s disease suggests that those who have poor results following implantation of electrodes to stimulate the brain may benefit from additional surgery to correct the electrode placement, according to a report in the May issue of Archives of Neurology, one of the JAMA/Archives journals.
Implanting electrodes that stimulate the subthalamic nucleus, a region deep in the brain potentially related to impulsivity, is effective in reducing medication doses and improving the symptoms of Parkinson’s disease, according to background information in the article. With this treatment, medication doses are often reduced by 50 percent to 65 percent, and scores on scales measuring motor function (generally impaired in Parkinson’s disease) typically improve by 40 percent to 70 percent. However, sometimes the surgery is less effective.
“The principal cause of these poor results arises from imprecision of electrode placement, leading to non-stimulation of the target as required,” the authors write. “Misplacement of the electrode by only a few millimeters may have occurred.”
Mathieu Anheim, M.D., of the University Hospital A. Michallon, Strasbourg, France, and colleagues studied seven consecutive patients age 49 to 70 with Parkinson’s disease who, despite electrode implantation, continued to experience severe symptoms. The patients were operated on again and the electrodes were re-implanted 12 to 23 months after the original surgery. Motor scores and medication doses were assessed one year after the second procedure.
All patients except for one displayed improvement after the second surgery. When they were not on medication, treatment improved the patient’s motor scores by 26.7 percent following the first operation and 59.4 percent following the second procedure. Their dose of levodopa, a medication treating Parkinson’s disease, decreased from 1,202 milligrams to 534 milligrams. The average distance between the electrodes and the target point of stimulation—a location in the subthalamic nucleus identified by evaluating electrode placement in patients whose surgery was successful—decreased from 5.4 to 2 millimeters. The shorter this distance, the greater the patient’s improvement in motor scores.
“Although appropriate patient selection is important for the desired surgical outcome, the key to marked improvement following subthalamic nucleus stimulation is optimal surgical technique for precise implantation of stimulation electrodes in the target. Although neurosurgeons aim to minimize shifts from the originally planned electrode positions, this does not exclude the possibility that inadequate surgical technique may be responsible for postoperative lack of benefit,” the authors write. “Patients demonstrating poor response to subthalamic nucleus stimulation as a result of electrode misplacement can benefit from re-implantation in the subthalamic nucleus closer to the theoretical target.”
(Arch Neurol. 2008;65[5]:612-616. Available to the media pre-embargo 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 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, May 12, 2008
Media Advisory: To contact corresponding author Joel G. Ray, M.D., M.Sc., F.R.C.P.C., call Julie Saccone at 416-864-5047.
HIGH BLOOD PRESSURE, HIGH CHOLESTEROL MAY BE ASSOCIATED WITH RETINAL VASCULAR DISEASE
CHICAGO—High blood pressure and high cholesterol levels appear to be risk factors for retinal vein occlusion, a condition that causes vision loss, according to a report in the May issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Retinal vein occlusion occurs when one or more veins carrying blood from the eye to the heart become blocked, according to background information in the article. Bleeding (hemorrhage) or fluid buildup (edema) may follow, damaging vision.
Paul R.A. O’Mahoney, of the Royal College of Surgeons in Ireland, Dublin, and colleagues conducted a meta-analysis of 21 previously published studies involving 2,916 individuals with retinal vein occlusion and 28,646 control participants without the condition. The researchers pooled data from all the studies and estimated the population-attributable risk, or the percentage of cases of retinal vein occlusion that could be attributed to hypertension (high blood pressure), diabetes and hyperlipidemia (high cholesterol).
Of patients with retinal vein occlusion, 63.6 percent had hypertension, compared with 36.2 percent of controls; those with high blood pressure had more than 3.5 times the odds of having retinal vein occlusion. High cholesterol levels were more than twice as common among patients with retinal vein occlusion as those without (35.1 percent vs. 16.7 percent), and those with high cholesterol levels had an approximately 2.5-fold higher risk of retinal vein occlusion. Diabetes was slightly more prevalent among those with retinal vein occlusion than among those without (14.6 percent vs. 11.1 percent).
“The pronounced population attributable risk percentage for hypertension (nearly 50 percent), hyperlipidemia (20 percent) and diabetes mellitus (5 percent) in persons with retinal vein occlusion, if causal, would mean that treatment of these diseases might be important in the primary and secondary prevention of retinal vein occlusion,” the authors write. “Accordingly, we recommend that an assessment of blood pressure and both fasting lipid and glucose levels be routinely performed in adults with any form of retinal vein occlusion.”
In addition, “those who treat patients with systemic hypertension, diabetes mellitus and hyperlipidemia should consider that each poses a risk not only to cardiovascular health but also to ocular health,” they conclude.
(Arch Ophthalmol. 2008;126[5]:692-699. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by the Division of Endocrinology and Metabolism, St. Michael’s Hospital and a Canadian Institutes for Health Research New Investigator Award. 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, May 12, 2008
Media Advisory: To contact Mark S. Juzych, M.D., M.H.S.A., call Julie O’Connor at 313-577-8845.
GLAUCOMA PATIENTS WITH POOR HEALTH LITERACY MAY HAVE GREATER DISEASE PROGRESSION
CHICAGO—Glaucoma patients in urban areas who have poor health literacy appear to miss more appointments and to have worse disease understanding and greater disease progression than patients with adequate health literacy, according to a report in the May issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
“Health literacy, as a discrete form of literacy, is increasingly important in health care,” according to background information in the article. “The U.S. Department of Health and Human Services defines health literacy as ‘the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions’.”
Mark S. Juzych, M.D., M.H.S.A., of the Kresge Eye Institute, Wayne State University, Detroit, and colleagues used a standardized test to determine the health literacy of 204 English-speaking patients treated for glaucoma for at least one year. Patients’ demographic information and glaucoma understanding were assessed through an oral questionnaire.
Of the 204 glaucoma patients, half were categorized as having poor health literacy and the other half were categorized as having adequate health literacy. “Being of white race, having an education of some college or more and having a household income of $20,000 or greater was associated with a lower likelihood of having poor health literacy,” the authors write.
On average, the poor literacy group had lower glaucoma understanding, missed more appointments per year and reported having missed taking eye drops more frequently than those in the adequate literacy group, with 65 patients having missed taking eye drops two or more times per month compared with only 34 patients in the adequate literacy group. Patients with poor health literacy also showed greater visual field loss at the beginning of the study and significantly worse visual field parameters when comparing recent and initial visual fields.
“Closing the gap in health literacy is one essential component in reducing disparities in glaucoma care. Screening patients for poor literacy is a first step,” the authors conclude. “However, the real challenge is in shaping effective public health communication that is culturally and linguistically appropriate for patients and promotes compliance with medications and follow-up treatment with their physicians.
“In addition, there is a need to improve physician communication, which should consider the needs and competencies of patients with poor health literacy.”
(Arch Ophthalmol. 2008;126[5]:718-724. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Penta Glaucoma Fund. 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, May 12, 2008
Media Advisory: To contact Joan A. Stelmack, O.D., M.P.H., call Jeanne Galatzer-Levy at 312-996-1583.
LOW-VISION REHABILITATION APPEARS TO IMPROVE VISUAL FUNCTION IN MACULAR DISEASE
CHICAGO—A low-vision rehabilitation program that includes a home visit, counseling, assistive devices such as magnifiers and assignments to practice using them appears to significantly improve vision in veterans with diseases of the macula (the area of the retina with the sharpest vision), according to a report in the May issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
“Low vision, chronic visual impairment that limits everyday function, is one of the 10 most prevalent causes of disability in America,” the authors write as background information in the article. In addition to affecting daily function, low vision increases the risk of depression, injury and an overall decline in health. Most diseases that cause low vision are not curable. “In most cases, impaired vision cannot be corrected and rehabilitation is the only option for regaining lost function for the patient with low vision. Low-vision rehabilitation aims to restore functional ability, the ability to perform tasks modulated by visual impairment.”
Joan A. Stelmack, O.D., M.P.H., of the Edward E. Hines Jr. VA Hospital, Hines, Ill., and the University of Illinois at Chicago College of Medicine, and colleagues studied 126 patients (average age 78.9, 98 percent male) with low vision and diseases affecting the macula who were eligible for Veterans Affairs (VA) services. Between November 2004 and November 2006, participants were randomly assigned to one of two groups. In one, patients received a low-vision rehabilitation program incorporating a low-vision examination, counseling, assistive devices such as magnifiers and five weekly sessions provided by a low-vision therapist to teach use of the assistive devices and other adaptive strategies. They were also assigned homework to ensure they used the devices outside of rehabilitation. The other group was placed on a wait list for the rehabilitation program and received no treatment for four months, an amount of time veterans might normally wait to receive such services.
After four months, the 64 patients in the treatment group received an average of 10.46 hours of face-to-face low-vision rehabilitation and experienced a significant improvement in all aspects of visual function, including reading ability. Among the 62 patients in the group that did not receive rehabilitation, vision and functional ability declined over the four-month follow-up. “Significant improvements in functional ability for mobility, visual information processing, visual motor skills and overall ability also were seen in the treatment group; small losses in these functions were observed in the control group,” the authors write.
“At least 10 hours of low-vision therapy, including a home visit and assigned homework to encourage practice, is justified for patients with moderate and severe vision loss from macular diseases,” they conclude. “Because the waiting-list control patients demonstrated a decline in functional ability, low-vision services should be offered as early as possible.”
(Arch Ophthalmol. 2008;126[5]:608-617.
Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Funding for this research was provided by a Department of Veterans Affairs Rehabilitation Research and Development grant. Funding for the low-vision devices prescribed and dispensed to veteran participants was provided by the Department of Veterans Affairs Prosthetics Service. 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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