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 26, 2008)
MANY PATIENTS WITH HEART DISEASE HAVE POOR KNOWLEDGE OF HEART ATTACK SYMPTOMS
SHORT-TERM USE OF ANTIPSYCHOTICS IN OLDER ADULTS WITH DEMENTIA ASSOCIATED WITH SERIOUS ADVERSE EVENTS
MANY MEN WITH LOW TESTOSTERONE LEVELS DO NOT RECEIVE TREATMENT
GENETIC MUTATION ASSOCIATED WITH INCREASED RISK OF LUNG CANCER
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 26, 2008
Media Advisory: To contact Kathleen Dracup, D.N.Sc., call Kristen Bole at 415-476-2743. To contact editorialist Robert A. Phillips, M.D., Ph.D., call the Office of Public Affairs at 508-856-2000.
MANY PATIENTS WITH HEART DISEASE HAVE POOR KNOWLEDGE OF HEART ATTACK SYMPTOMS
CHICAGO—Nearly half of patients with a history of heart disease have poor knowledge about the symptoms of a heart attack and do not perceive themselves to have an elevated cardiovascular risk, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“The insulin-sensitizing thiazolidinediones are a relatively new and effective class of oral antidiabetic agents that have gained wide Individuals with heart disease have five to seven times the risk of having a heart attack or dying as the general population, according to background information in the article. Survival rates improve following heart attack if treatment begins within one hour. However, most patients are admitted to the hospital 2.5 to three hours after symptoms begin. “Barriers to seeking appropriate care quickly are both cognitive and emotional,” the authors write. If patients do not know the symptoms of acute myocardial infarction (heart attack) and other acute coronary syndromes—including nausea and pain in the jaw, chest or left arm—they will not seek treatment for them. If they do not perceive themselves to be at risk for heart attack, they will look for another explanation when they experience these symptoms.
Kathleen Dracup, D.N.Sc., of the University of California, San Francisco, School of Nursing, and colleagues surveyed 3,522 patients (average age 67) who had a history of heart attack or an invasive procedure for treating narrowed arteries. The patients were asked to identify possible symptoms of heart attack and responded to true-false questions about heart disease. Participants also were asked whether they were more or less likely than other individuals their age to have a heart attack in the next five years.
The average cardiac knowledge score was 71 percent. Despite their history of heart disease, 44 percent of the patients had low knowledge levels, as documented by scores of less than 70 percent. Women, individuals who had participated in cardiac rehabilitation, those with higher education levels, younger individuals and those who received care from a cardiologist as opposed to a family practitioner or internist tended to score higher.
“In this group of patients, who were all at high risk for a future acute myocardial infarction, 43 percent inappropriately assessed their risk as less than or the same as other people their age,” the authors write. “More men than women perceived themselves as being at low risk (47 percent vs. 36 percent, respectively).”
Changes in the health care delivery system have led to less hospital time for heart disease patients, reducing the amount of time available for education about heart disease symptoms, the authors note. “Patients require continued reinforcement about the nature of cardiac symptoms, the benefits of early treatment and their risk status,” they write. “Our findings suggest that men, elderly individuals, those with low levels of education and those who have not attended a cardiac rehabilitation program are more likely to require special efforts during medical office visits to review symptoms of acute myocardial infarction and to learn the appropriate actions to take in the face of new symptoms of acute coronary syndromes.”
(Arch Intern Med. 2008;168[10]:1049-1054. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Funding was provided by the National Institute of Nursing Research, National Institutes of Health. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: FINDINGS ENCOURAGE SUPPORT OF CARDIAC REHABILITATION
The researchers “found two modifiable factors identified with increased knowledge about coronary artery disease: participation in cardiac rehabilitation and receiving care by a cardiologist,” writes Robert A. Phillips, M.D., Ph.D., of the UMass Memorial Medical Center, Worcester, in an accompanying editorial.
“These findings should help to fuel the recent focus on the barriers, benefits and methods to improve participation in cardiac rehabilitation by coronary artery disease patients,” he continues.
“Health care theory suggests that the highest level of care is provided when payments and best health care practices are aligned. To this end, payers such as Centers for Medicare and Medicaid Services and private insurers should develop a tiered approach to payment for cardiac care, providing higher reimbursements for those hospitals that offer cardiac rehabilitation and higher reimbursement to physicians and hospitals who consistently refer eligible patients for cardiac rehabilitation,” Dr. Phillips concludes.
(Arch Intern Med. 2008;168[10]:1029. 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 26, 2008
Media Advisory: To contact Paula A. Rochon, M.D., M.P.H., F.R.C.P.C., call Kristine Galka at 416-480-4780.
SHORT-TERM USE OF ANTIPSYCHOTICS IN OLDER ADULTS WITH DEMENTIA ASSOCIATED WITH SERIOUS ADVERSE EVENTS
CHICAGO—Older adults with dementia who receive short-term courses of antipsychotic medications are more likely to be hospitalized or die than those who do not take the drugs, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
“Newer antipsychotic drugs (olanzapine, quetiapine fumarate and risperidone) have been on the market for more than a decade and are commonly used to treat the behavioral and psychological symptoms of dementia,” the authors write as background information in the article. “Antipsychotic drugs are often used for short periods to treat agitation in clinical practice. They are frequently prescribed around the time of nursing home admission.” About 17 percent of individuals admitted to nursing homes are starting on antipsychotic medication within 100 days, and 10 percent receive only a single prescription. Given the widespread use of short-term prescriptions, it is important to evaluate their safety, the authors note.
Paula A. Rochon, M.D., M.P.H., F.R.C.P.C., of the Institute for Clinical Evaluative Sciences (ICES), Ontario, and colleagues studied older adults with dementia living in the community or in nursing homes between 1997 and 2004. In each setting, the researchers identified three groups of equal size who were identical except for their exposure to antipsychotic medications. Among 20,682 older adults with dementia living in the community, 6,894 did not receive antipsychotics, 6,894 were prescribed atypical or newer antipsychotics and 6,894 were prescribed conventional antipsychotics, such as haloperidol or loxaprine. Among 20,559 older adults with dementia living in nursing homes, 6,853 received no antipsychotics, 6,853 received atypical antipsychotics and 6,853 received conventional antipsychotics.
Participants’ medical records were examined for serious adverse events, defined as hospital admissions and death within 30 days of beginning therapy. “Relative to community-dwelling older adults with dementia who did not receive a prescription for antipsychotic drugs, similar older adults who did receive atypical antipsychotic drugs were three times more likely and those who received a conventional antipsychotic drug were almost four times more likely to experience a serious adverse event within 30 days of starting therapy,” the authors write. “Relative to nursing home residents in the control group, individuals in the conventional antipsychotic therapy group were 2.4 times more likely to experience a serious adverse event leading to an acute care hospital admission or death. Those in the atypical antipsychotic group were 1.9 times more likely to experience a serious adverse event during 30 days of follow-up.”
The analysis may underestimate the number of adverse events because of the short length of follow-up, the authors note. In addition, physicians who notice early signs of a problem may take patients off antipsychotics, avoiding more serious consequences, and many serious events experienced by nursing home residents are dealt with in the facility without hospital admission. “Our results exploring serious adverse events likely identify only the ‘tip of the iceberg’,” they write. “Antipsychotic drugs should be prescribed with caution even for short-term therapy.”
(Arch Intern Med. 2008;168[10]:1090-1096. 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 26, 2008
Media Advisory: To contact Susan A. Hall, Ph.D., call Lisa Marceau, M.P.H., at 617-923-7747.
MANY MEN WITH LOW TESTOSTERONE LEVELS DO NOT RECEIVE TREATMENT
CHICAGO—The majority of men with androgen deficiency may not be receiving treatment despite having sufficient access to care, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Androgen deficiency in men means the body has lower than normal amounts of male hormones, including testosterone, according to background information in the article. Although prescriptions for testosterone therapy for aging men have increased in recent years, treatment patterns for androgen deficiency are not clearly understood in community-dwelling U.S. males.
Susan A. Hall, Ph.D., of New England Research Institutes, Watertown, Mass., and colleagues examined data collected from 1,486 Boston-area men (average age 46.4) from April 2002 to June 2005 to estimate the number of men receiving treatment for androgen deficiency, to explain how treated and untreated men varied in seeking care and to understand potential barriers to health care. Specific symptoms of androgen deficiency include low libido, erectile dysfunction and osteoporosis and less-specific symptoms include sleep disturbance, depressed mood and tiredness.
A total of 97 men met the criteria for having androgen deficiency. Eighty-six men were symptomatic and untreated, and 11 were prescribed testosterone treatment. “Men were using the following: testosterone gel (n=1), testosterone patch (n=3), testosterone cream (n=1), testosterone cypionate [an injectictable form of testosterone] (n=1) or unspecified formulations of testosterone (n=5),” the authors write. “All of the unspecified forms of testosterone used were self-reported as administered in intervals defined in weeks, which suggests that these were injectable formulations.”
“Men with untreated androgen deficiency were the most likely of the three groups to have low socioeconomic status, to have no health insurance and to receive primary care in an emergency department or hospital outpatient clinic,” the authors write. However, all men with treated and untreated androgen deficiency were more likely to report receiving regular care than those without the condition and reported visiting their doctor more often throughout the year (with averages of 15.1 visits for those with untreated androgen deficiency, 6.7 visits for those without the condition and 12 visits for those with treated androgen deficiency).
“Under our assumptions, a large majority (87.8 percent) of 97 men in our groups with androgen deficiency were not receiving treatment despite adequate access to care,” the authors conclude. “The reasons for this are unknown but could be due to unrecognized androgen deficiency or unwillingness to prescribe testosterone therapy.”
(Arch Intern Med. 2008;168[10]:1070-1076. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by an unrestricted educational grant to New England Research Institutes (NERI) from GlaxoSmithKline (GSK). The Boston Area Community Health Study is supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases. 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 26, 2008
Media Advisory: To contact Ping Yang, M.D., Ph.D., call Traci Klein at 507-284-5005.
GENETIC MUTATION ASSOCIATED WITH INCREASED RISK OF LUNG CANCER
CHICAGO—Carriers of a common genetic disorder previously linked to lung disease may have a 70-percent to 100-percent increased risk of lung cancer, according to a report in the May 26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
The disorder, alpha1-antitrypsin deficiency (α1ATD), is one of the most common genetic conditions affecting the U.S. population and especially those of European descent, according to background information in the article. Individuals with two copies of the associated genetic mutation often develop emphysema at an early age. However, α1ATD carriers—those with only one copy of the mutated gene—do not normally have severe diseases related to α1ATD and may not be aware of their status. However, they may be more vulnerable to cancer-causing tobacco smoke than non-carriers.
Ping Yang, M.D., Ph.D., and colleagues at the Mayo Clinic, Rochester, Minn., tested for α1ATD carrier status in 1,443 patients with lung cancer. In addition, 797 community members without lung cancer and 902 siblings of lung cancer patients were tested as controls. Information was gathered about all participants’ smoking history, demographic characteristics and family history of cancer.
A total of 13.4 percent of the lung cancer patients and 7.8 percent of unrelated controls were α1ATD carriers. When patients with lung cancer were compared to non-related controls, α1ATD carriers had a 70 percent higher risk of developing lung cancer than non-carriers. Comparing patients with lung cancer to their cancer-free siblings, α1ATD carriers had twice the risk of developing lung cancer. The researchers estimated that α1ATD carrier status may account for 11 percent to 12 percent of the patients with lung cancer enrolled in the study.
Among those who had never smoked, α1ATD carrier status was associated with a 2.2-fold higher risk of lung cancer, with a 2-fold increased risk among light smokers and a 2.3-fold increased risk among moderate to heavy smokers. “Patients with a family history of lung cancer or other cancers in their first-degree relatives had a similar α1ATD carrier rate to those without such a family history, all significantly higher than the controls,” the authors write. “This finding suggests that increased lung cancer risk among α1ATD carriers is independent of a family history of cancer.”
“In summary, our findings demonstrate a paradigm in lung cancer etiology research and risk assessment that incorporates clinical and genetic markers for lung damage into a gene-environment interaction,” they conclude. “This knowledge may prove to be useful in further understanding the pathologic mechanisms of lung cancer development and in refining lung cancer risk assessment.”
(Arch Intern Med. 2008;168[10]:1097-1103. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institutes of Health. 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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