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, June 23, 2008)
SUBTLE NERVOUS SYSTEM ABNORMALITIES APPEAR TO PREDICT RISK OF DEATH IN OLDER INDIVIDUALS
LOW VITAMIN D LEVELS ASSOCIATED WITH DEATH FROM CARDIOVASCULAR, ALL CAUSES
STUDY EXAMINES PREVALENCE OF CHEST PAIN IN PATIENTS ONE YEAR AFTER HEART ATTACK
PERSONAL BENEFIT, HELPING OTHERS MOTIVATE CLINICAL TRIAL PARTICIPANTS
STUDY EVALUATES FACTORS ASSOCIATED WITH RACIAL DISPARITIES IN COLON CANCER SCREENING
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 23, 2008
Media Advisory: To contact Marco Inzitari, M.D., e-mail: marcoinzitari{at}gmail.com. To contact corresponding editorialist Malaz Boustani, M.D., M.P.H., call Cindy Fox Aisen at 317-274-7722.
SUBTLE NERVOUS SYSTEM ABNORMALITIES APPEAR TO PREDICT RISK OF DEATH IN OLDER INDIVIDUALS
CHICAGO—Subtle but clinically detectable neurological abnormalities, such as reduced reflexes and an unstable posture, may be associated with the risk of death and stroke in otherwise healthy older adults, according to a report in the June 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Previous research has linked subtle neurological abnormalities—which also include resting tremors and differences in hand strength—to poor physical function and to falls, according to background information in the article. In addition, other studies of apparently healthy older individuals have shown that those with subclinical diseases of different organs, such as subtle signs of heart trouble that have not yet led to a heart disease diagnosis, are more likely to become physically or mentally impaired.
Marco Inzitari, M.D., of the University of Florence, Italy, and colleagues studied 506 individuals (average age 72.5) who did not have neurological disease beginning in 1995. A neurological examination was administered then and again four years later. Deaths and cerebrovascular events, such as stroke, were tracked for an average of eight years.
At the beginning of the study, 59 percent of the participants had at least one subtle neurological abnormality, with an overall average of 1.1 per individual. After adjusting for age and sex, an increasing number of such abnormalities was associated with more severe disabilities, more symptoms of depression and declining cognitive (thinking, learning and memory) and functional status. Compared with individuals who had fewer than three subtle neurological abnormalities, those who had three or more subtle neurological abnormalities were more likely to die or experience a cerebrovascular event over eight years.
Based on these findings, “a simple neurological examination seems to be an additional prognosticator of hard outcomes, particularly death, above and beyond other measures used in clinical practice,” which currently include other performance-based tests for cognitive and physical function and depressive symptoms, the authors write. “It is likely that the neurological examination might capture additional information about the integrity of the nervous system in apparently healthy older adults.”
“Our data support the hypothesis that subtle neurological abnormalities in elderly individuals are a manifestation of early brain damage, a finding that may have important implications in research studies on the prevention of age-related cognitive and functional decline. Understanding the nature of dysfunctions underlying the decline in physical performance and disability contributes to planning specific preventive interventions,” they conclude.
(Arch Intern Med. 2008;168[12]:1270-1276. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by the Italian Ministry of Scientific and Technological Research (National Special Project on Heart Failure), by the government of Tuscany and by the Azienda Ospedaliero-Universitaria Careggi-Firenze, Italy. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: FINDINGS USEFUL FOR RESEARCH, CLINICAL PRACTICE
Combining the new findings with previous work about life expectancy, “a typical physician caring for a healthy older adult could use a simple routine neurological examination to provide his or her patients with valuable prognostic information,” write Malaz Boustani, M.D., M.P.H., and Michael D. Justiss, Ph.D., of the Regenstrief Institute Inc., Indianapolis, and colleagues in an accompanying editorial.
The scale could also be used to identify at-risk older adults and enroll them in research studies of interventions to prevent disability and eventually increase the active life expectancy of the aging population, Drs. Boustani and Justiss note.
(Arch Intern Med. 2008;168[12]:1252-1253. 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, June 23, 2008
Media Advisory: To contact Harald Dobnig, M.D., e-mail: harald.dobnig{at}meduni-graz.at.
LOW VITAMIN D LEVELS ASSOCIATED WITH DEATH FROM CARDIOVASCULAR, ALL CAUSES
CHICAGO—Individuals with lower blood levels of vitamin D appear to have an increased risk of death overall and from cardiovascular causes, according to a report in the June 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
A recent consensus panel estimated that about 50 percent to 60 percent of older individuals in North America and the rest of the world do not have satisfactory vitamin D status, and the situation is similar for younger individuals, according to background information in the article. Blood levels of 25-hydroxyvitamin D, a measure of blood vitamin D levels, lower than 20 to 30 nanograms per milliliter have been associated with falls, fractures, cancer, immune dysfunction, cardiovascular disease and hypertension. These effects are thought to be mediated by the compound 1,25-dihydroxyvitamin D, which is produced by the body and also converted from 25-hydroxyvitamin D.
Harald Dobnig, M.D., of Medical University of Graz, Austria, and colleagues studied 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D levels in 3,258 consecutive patients (average age 62 years) who were scheduled for coronary angiography testing at a single medical center between 1997 and 2000.
During about 7.7 years of follow-up, 737 (22.6 percent) of participants died, including 463 (62.8 percent) who died of cardiovascular causes. Death rates from any cause and from cardiovascular causes were higher among individuals in the lower one-half of 25-hydroxyvitamin D levels and the lowest one-fourth of 1,25-dihydroxyvitamin D levels. These associations remained when the researchers accounted for other factors, including coronary artery disease, physical activity level and co-occurring diseases.
Low 25-hydroxyvitamin D levels also were correlated with markers of inflammation such as C-reactive protein, as well as signs of oxidative (oxygen-related) damage to cells, the authors note.
“Apart from the proved effects that vitamin D has on bone metabolism and neuromuscular function, appropriate serum levels (that may also be higher than in the present investigation) are associated with a decrease in mortality,” they conclude. “Although not proved, it seems possible that at least part of this effect may be due to lowering of a risk profile promoting atherosclerosis [narrowing of the arteries] and preventing cardiovascular end points.”
“Based on the findings of this study, a serum 25-hydroxyvitamin D level of 20 nanograms per milliliter or higher may be advised for maintaining general health.”
(Arch Intern Med. 2008;168[12]:1340-1349. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The LURIC study has received unrestricted grants from Sanofi-Aventis, Roche, Dade Behring and AstraZeneca. 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, June 23, 2008
Media Advisory: To contact Thomas M. Maddox, M.D., S.M., call Christina White at 303-393-5205.
STUDY EXAMINES PREVALENCE OF CHEST PAIN IN PATIENTS ONE YEAR AFTER HEART ATTACK
CHICAGO—Nearly one in five patients experiences chest pain one year after having a heart attack, according to a report in the June 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
One of the main goals of in-hospital treatment and outpatient care after heart attack is to relieve angina (or episodic chest pain), according to background information in the article. The prevalence and treatment of chest pain one year after heart attack are largely unknown. “By identifying these factors, a more complete understanding of those patients who are at the greatest risk for angina [chest pain] after myocardial infarction [heart attack] can occur,” the authors write. Identifying this population is important for treating remaining chest pain and improving patient outcomes, including ability to exercise and health-related quality of life.
Thomas M. Maddox, M.D., S.M., of Denver Veterans Affairs Medical Center and University of Colorado Denver, and colleagues studied the occurrence of angina in 1,957 patients recruited from January 2003 to June 2004. Patients filled out questionnaires assessing their chest pain one year after hospitalization for heart attack. Sociodemographic, clinical and other lifestyle factors were also reported.
Of all patients, 389 (19.9 percent) reported angina one year after hospitalization for heart attack. Twenty-four patients (1.2 percent) reported having daily chest pain, 59 (3 percent) reported weekly chest pain and 306 (15.6 percent) reported having chest pain less than once a week.
Patients experiencing chest pain one year after heart attack were more likely to be younger, non-white males with prior chest pain who have undergone prior coronary artery bypass graft surgery and have experienced recurring rest chest pain while hospitalized for heart attack. Patients with one-year chest pain were also more likely to continue smoking, to undergo revascularization (surgery to reestablish blood flow to the heart) after hospitalization and to have significant new, persistent or fleeting depressive symptoms.
“Multiple factors were associated with one-year angina, including demographic, clinical, inpatient and outpatient characteristics. Recognition of these relationships will be important in monitoring at-risk patients after acute myocardial infarction,” the authors conclude. “In addition, future investigation into modifiable factors, such as depression and smoking cessation, will be important in the quest to alleviate angina and improve subsequent cardiac outcomes among patients after myocardial infarction.”
(Arch Intern Med. 2008;168[12]:1310-1316. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by CV Therapeutics Inc., Palo Alto, California, and in part by a grant from the National Institutes of Health Specialized Centers of Clinically Oriented 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, June 23, 2008
Media Advisory: To contact co-author Christine Grady, Ph.D., R.N., call Sara Byars at 301-496-2563.
PERSONAL BENEFIT, HELPING OTHERS MOTIVATE CLINICAL TRIAL PARTICIPANTS
CHICAGO—Most HIV-infected individuals participating in a clinical trial hope to benefit personally from the research but also understand they are contributing to society, according to a report in the June 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Although there is a growing body of data explaining why individuals enroll in clinical trials, little research has been conducted regarding their motivation for ongoing participation, according to background information in the article. “Why do patient participants, especially those randomized to a control group, continue to accept the added risks and burdens, e.g., additional clinic visits and extra research procedures, that clinical research places on them?” the authors write. “Answering this question is especially important given the view that clinical research inappropriately exploits patient participants by exposing them to added risks and burdens for the benefit of others.”
David Wendler, Ph.D., and colleagues at the Department of Bioethics, National Institutes of Health, reported group results of a survey of participants in the Evaluation of Subcutaneous Proleukin (Interleukin-2) in a Randomized International Trial (ESPRIT) study. ESPRIT is a phase 3 trial comparing antiretroviral medications alone to antiretroviral medications plus interleukin 2 (IL-2), a protein associated with the immune system. HIV-infected patients from Argentina, Brazil and Thailand who had been enrolled in the study for at least six months responded to questions regarding their motivations and experiences.
Of the 582 participants who responded to the follow-up survey, 292 were in the treatment group receiving IL-2 and 290 were in the group receiving antiretroviral medication alone. Participants were asked to choose from a list of 12 reasons why they continued to participate in the trial. “More than 80 percent indicated that the opportunity to obtain medical or personal benefit and the opportunity to help others were very important reasons for continuing to participate,” the authors write. “Also, 90 percent believed they were making an important contribution to society, and 84 percent expressed pride in helping to advance scientific knowledge.”
The findings suggest that patients can have multiple reasons for continuing to participate in clinical research. “Most importantly, the fact that respondents were motivated to obtain treatment for a life-threatening illness did not preclude them from being motivated to help others through their participation in the ESPRIT study as well,” the authors conclude.
“These findings reveal that it is possible to conduct clinical research in developing countries without exploiting patient participants’ failure to understand that they are participating in research and without exploiting their need for medical treatment to get them to contribute to goals that they do not endorse.”
(Arch Intern Med. 2008;168[12]:1294-1299. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Department of Bioethics at the National Institutes of Health Clinical 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, June 23, 2008
Media Advisory: To contact Anthony F. Jerant, M.D., call Karen Finney at 916-734-9064.
STUDY EVALUATES FACTORS ASSOCIATED WITH RACIAL DISPARITIES IN COLON CANCER SCREENING
CHICAGO—Blacks and Hispanics appear less likely to undergo colorectal cancer screening than whites because of socioeconomic, health care access and language barriers, according to a report in the June 23 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, other factors may contribute to screening disparities experienced by Asians.
Colorectal cancer screening rates lag behind those for other cancer screening tests, according to background information in the article. In addition, marked disparities appear to exist between non-Hispanic whites and racial and ethnic minorities in the United States. “Such disparities in screening may contribute to the higher colorectal cancer incidence and mortality [death] rates observed in racial/ethnic minorities relative to non-Hispanic whites,” the authors write.
Anthony F. Jerant, M.D., and colleagues at the University of California Davis School of Medicine, Sacramento, analyzed data from two national surveys conducted between 2000 and 2005. A total of 22,973 adults age 50 and older answered questions about demographics, colorectal cancer screening behaviors and other social and health care factors.
Overall, 54.1 percent of the participants were screened for colorectal cancer using either colonoscopy or fecal occult blood testing (FOBT). Individuals in racial and ethnic minority groups were less likely than whites to be tested—33.8 percent of Asians, 48.2 percent of blacks and 36.7 percent of Hispanics underwent a screening procedure, compared with 57.2 percent of whites.
After adjusting for other factors associated with screening behavior—including demographics, socioeconomic variables, language spoken at home, health care access and self-rated health—disparities between blacks, Hispanics and whites disappeared, the authors note. “Beyond socioeconomic factors, which disproportionately affect minorities, these findings suggest the effect of access and, for Hispanics, language-appropriate care on colorectal cancer screening uptake,” they write.
However, after adjusting for the same factors, disparities between whites and Asians remained significant. “Although this study does not permit firm conclusions regarding the reason for this finding, the implication is that unmeasured cultural factors may contribute to the Asian/non-Hispanic white disparity in colorectal cancer screening,” the authors write. “Less acculturated Asian individuals in the United States may have core health beliefs and values that differ from those in the ‘Western’ health model, leading them to decline FOBT or endoscopy offered in the absence of worrisome symptoms. They may also be less likely to be offered colorectal cancer screening.”
The findings suggest that different types of programs may improve screening rates in separate minority groups, the authors conclude. Culturally targeted interventions for patients and physicians may help address Asian individuals, enhancing access to health care may help mitigate disparities between white and black patients and maximizing access and offering language-appropriate care and information may increase the number of Hispanics who are screened.
(Arch Intern Med. 2008;168[12]:1317-1324. 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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