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, September 8, 2008)
OLDER WOMEN WHO GET LITTLE SLEEP MAY HAVE A HIGHER RISK OF FALLING
PHYSICAL ACTIVITY ASSOCIATED WITH REDUCED RISK FOR OBESITY IN GENETICALLY PREDISPOSED
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 8, 2008)
NEED TO LOWER HIGH BLOOD PRESSURE AFTER STROKE SHOULD NOT NECESSARILY RULE OUT USE OF CLOT-BUSTING TREATMENT
PAIN APPEARS COMMON AMONG PATIENTS WITH PARKINSON’S DISEASE
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 8, 2008)
STUDY EXAMINES GOLF-RELATED EYE INJURIES IN CHILDREN
SURVEY FINDS SPIRITUALITY IS IMPORTANT TO EYE PATIENTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 8, 2008
Media Advisory: To contact Katie L. Stone, Ph.D., call Kevin McCormack at 415-600-7484.
OLDER WOMEN WHO GET LITTLE SLEEP MAY HAVE A HIGHER RISK OF FALLING
CHICAGO—Women age 70 and older who sleep five hours or less per night may be more likely to experience falls than those who sleep more than seven to eight hours per night, according to a report in the September 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. Additionally, the use of sleep medications does not appear to influence the association between sleep and risk of falling.
“Falls pose a major health risk among older adults and are a leading cause of mortality [death], morbidity [illness] and premature nursing home placement,” according to background information in the article. About one-third of adults older than age 65 experience falls each year. Insomnia and disturbed sleep as well as the use of benzodiazepines (hypnotic medications to treat insomnia) are increasingly common in older adults. “It is not established whether it is poor sleep or medications used to treat sleep disturbances that explain the increased risk of falls in those who are prescribed such medications.”
Katie L. Stone, Ph.D., of the California Pacific Medical Center Research Institute, San Francisco, and colleagues used wrist actigraphies (watch-like devices) and sleep diaries to measure sleep, sleep efficiency (the percentage of time in bed spent sleeping) and frequency of falls in 2,978 women age 70 and older. Questionnaires were used to determine demographic information and use of benzodiazepines.
Participants averaged 6.8 hours of sleep per night and spent an average 77.2 minutes awake after initial sleep onset. The average number of falls one year after the collection of sleep data was 0.84. “A total of 549 women (18.4 percent) had two or more falls during the year after the sleep assessments,” the authors write.
The risk of having two or more falls during the following year was higher for women who slept five hours or less per night compared with women who slept more than seven to eight hours per night. Compared with those with a sleep efficiency of 70 percent or higher, those with a sleep efficiency of less than 70 percent were 1.36 times more likely to experience a fall. Similarly, women with greater wake time after sleep onset (120 minutes or more) were 1.33 times more likely to fall than those who spent less than 120 minutes awake after sleep onset.
“In all, 214 subjects (7.2 percent) reported current use of benzodiazepines,” the authors write. “Use of any benzodiazepine (short and long combined) was associated with a 1.34-fold increase in risk of falls, whereas short- and long-acting benzodiazepine use was associated with an increased odds of 1.43 and 1.18, respectively.”
“Future studies, in particular randomized trials, are needed to determine the effects of newer pharmaceutical interventions for insomnia (e.g., benzodiazepine receptor agonists) or cognitive behavioral therapy for insomnia on risk of falls,” the authors conclude. “In addition, future studies using comprehensive and objective measures of sleep should examine the interrelationships between specific sleep characteristics (e.g., sleep-related breathing disorder, hypoxia and measures of sleep duration and fragmentation) to determine if these disorders contribute independently toward risk of falls.”
(Arch Intern Med. 2008;168[16]:1768-1775. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by Public Health Service grants. 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, September 8, 2008
Media Advisory: To contact Evadnie Rampersaud, M.S.P.H., Ph.D., call Jeanne Antol Krull at 305-243-4853.
PHYSICAL ACTIVITY ASSOCIATED WITH REDUCED RISK FOR OBESITY IN GENETICALLY PREDISPOSED
CHICAGO—Individuals who have a genetic mutation associated with high body mass index (BMI) may be able to offset their increased risk for obesity through physical activity, according to a report in the September 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
There is a widely acknowledged genetic component to BMI and obesity, according to background information in the article. Recently, a strong association has been shown between BMI and variants of one gene, known as the fat mass and obesity associated (FTO) gene. The mutations associated with obesity are present in about 30 percent of European populations and are associated with a 1.75-kilogram (about 3.9 pounds) increase in body weight. Lifestyle factors such as diet and physical activity are also important contributors to weight gain, but it is unknown exactly how they interact with genetics.
Evadnie Rampersaud, M.S.P.H., Ph.D., then of the University of Maryland, Baltimore, and now of the University of Miami, and colleagues analyzed DNA samples of 704 healthy Amish adults (average age 43.6, 53 percent men and 47 percent women) recruited from 2003 to 2007. Participants also underwent a series of physiological tests, including a seven-day measurement of physical activity using an instrument known as an accelerometer.
A total of 54 percent of the men and 63.7 percent of the women were overweight, and 10.1 percent of the men and 30.5 percent of the women were obese. In the genetic analysis, 26 single-nucleotide polymorphisms (SNPs, or changes in a single base letter of DNA) in the FTO gene were associated with BMI.
The researchers then divided participants into two groups based on their physical activity levels and assessed the relationship between BMI and the two strongest SNPs. Both SNPs were associated with BMI only in individuals who had low physical activity scores for their age and sex; they had no effect on those with above-average physical activity scores.
“Activity levels in the ‘high-activity’ stratum were approximately 900 calories [860 calories for women and 980 calories for men] higher than in the ‘low-activity’ stratum, which, depending on body size, corresponds to about three to four hours of moderately intensive physical activity, such as brisk walking, house cleaning or gardening,” the authors write.
“In conclusion, we have replicated the associations of common SNPs in the FTO gene with increased BMI and risk to obesity in the Old Order Amish,” they conclude. “Furthermore, we provide quantitative data to show that the weight increase resulting from the presence of these SNPs is much smaller and not statistically significant in subjects who are very physically active. This finding offers some clues to the mechanism by which FTO influences changes in BMI and may have important implications in targeting personalized lifestyle recommendations to prevent obesity in genetically susceptible individuals.”
(Arch Intern Med. 2008;168[16]:1791-1797. 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, September 8, 2008
Media Advisory: To contact corresponding author Sean I. Savitz, M.D., call Deborah Mann Lake at 713-500-3030.
NEED TO LOWER HIGH BLOOD PRESSURE AFTER STROKE SHOULD NOT NECESSARILY RULE OUT USE OF CLOT-BUSTING TREATMENT
CHICAGO—Patients who require therapy to lower their blood pressure following a stroke do not appear to be at a higher risk for bleeding or other adverse outcomes after receiving anti-clotting therapy, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.
Patients who have an acute ischemic stroke—in which a clot blocks blood flow to the brain—often have elevated blood pressure, according to background information in the article. “As many as 10 percent of otherwise eligible patients do not receive tissue plasminogen activator (tPA), the only proved therapy for acute ischemic stroke, because of severely elevated blood pressure,” the authors write. “In the past, guidelines recommended against giving tPA to treat acute ischemic stroke when aggressive measures (such as continuous infusion or more than two infusions of anti-hypertensive agents) are required to maintain blood pressure lower than 185/110 milligrams of mercury.”
Sheryl Martin-Schild, M.D., Ph.D., then of the University of Texas Health Sciences Center at Houston and now of Tulane University Health Sciences Center, New Orleans, and colleagues reviewed the medical records of 178 patients with acute ischemic stroke who received intravenous tPA within three hours. Of these, 50 required treatment for lowering blood pressure before beginning tPA therapy. This included 24 (48 percent) who received the medication nicardipine, either alone or in combination with the drug labetalol.
“We observed several important differences between patients who required blood pressure–lowering treatment and those who did not,” the authors write. “They had more severe strokes and their blood glucose concentration was higher, predicting they would have a worse outcome if all other factors were equal. As expected, they more frequently had a history of hypertension.”
After controlling for these factors—including age, baseline stroke severity and blood glucose levels—there were no differences between patients who received antihypertensive treatments and those who didn’t in adverse events, poor outcomes or stroke severity scores at discharge.
“Overall, the results of the present study provide the first experimental support for the revised American Heart Association guidelines allowing tPA therapy in patients requiring aggressive blood pressure management and also provides support for the use of nicardipine in patients with acute ischemic stroke who are eligible for thrombolytic therapy,” the authors conclude. “Aggressive control of severely elevated blood pressure is feasible and should not automatically exclude otherwise eligible patients with acute ischemic stroke from receiving thrombolytic therapy.”
(Arch Neurol. 2008;65[9]:1174-1178. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a training grant from the National Institutes of Health to the University of Texas Medical School at Houston Stroke Program. 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, September 8, 2008
Media Advisory: To contact Giovanni Defazio, M.D., Ph.D., e-mail: gdefazio{at}neurol.uniba.it.
PAIN APPEARS COMMON AMONG PATIENTS WITH PARKINSON’S DISEASE
CHICAGO—Pain appears to be more common in individuals with Parkinson’s disease than in those without, suggesting that pain is associated with the condition, according to a report in the September issue of Archives of Neurology, one of the JAMA/Archives journals.
“Patients with Parkinson’s disease often complain of painful sensations that may involve body parts affected and unaffected by dystonia,” or involuntary muscle contractions, the authors write as background information in the article. This pain may resemble cramping or arthritis, or have features of pain caused by nerve damage. “The high frequency of these pain disorders in the general population makes it hard to establish whether pain is more frequent among people with Parkinson’s disease than among age-matched controls.”
Giovanni Defazio, M.D., Ph.D., of the University of Bari, Italy, and colleagues compared 402 patients with Parkinson’s disease to 317 healthy individuals who were the same age. Participants provided information about their current age, the age at which they developed Parkinson’s disease, scores on disease rating scales and details regarding any pain that was present at the time of the study and lasted for at least three months.
Overall, pain was more common among Parkinson’s disease patients than among controls (281 or 69.9 percent vs. 199 or 62.8 percent). This was mainly attributable to dystonic pain, as rates of pain not associated with dystonia were similar among individuals with Parkinson’s disease (267 or 66.4 percent) and those without (199 or 62.8 percent).
“Nevertheless, we observed a significant association between Parkinson’s disease and non-dystonic pain, beginning after the onset of parkinsonian symptoms,” the authors write. “Cramping and central neuropathic [nervous system–related] pain were more frequent among Parkinson’s disease patients than controls. About one-quarter of patients who experienced pain reported pain onset before starting antiparkinsonian therapy.”
Basal ganglia, structures deep in the brain that control movement and are damaged in patients with Parkinson’s disease, also are involved with pain processing, the authors note. This might account for the increase in pain associated with Parkinson’s disease.
“These data support the hypothesis that pain begins at clinical onset of Parkinson’s disease or thereafter as a non-motor feature of Parkinson’s disease,” they conclude. “The findings of this study may have implications for designing studies aimed at understanding pain mechanisms in Parkinson’s disease and identifying specific treatment strategies.”
(Arch Neurol. 2008;65[9]:1191-1194. 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, September 8, 2008
Media Advisory: To contact corresponding author Vikram D. Durairaj, M.D., call Jacque Montgomery at 303-724-1528.
STUDY EXAMINES GOLF-RELATED EYE INJURIES IN CHILDREN
CHICAGO—Pediatric golf injuries are rare but can be devastating to the eye and vision system, according to a report in the September issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
The National Society to Prevent Blindness estimates that 900,000 Americans are visually impaired due to trauma, according to background information in the article. Sports-related injuries comprise only a small percentage of those, but are often more severe and cause more vision problems than other eye injuries. About 42,000 patients are treated each year for sports-related eye injuries, a number that appears to be increasing; approximately 1.5 percent to 5.6 percent of these eye injuries from sports are golf-related.
Eric M. Hink, M.D., of the University of Colorado School of Medicine, Denver, and colleagues studied 11 pediatric patients treated for golf-related eye injuries at two institutions over 15 years. The children, six boys and five girls, had an average age of 10.2 and were followed up for an average of one year.
“Ten patients (91 percent) were injured by golf clubs and one patient (9 percent) by a golf ball,” the authors write. “One injury (9 percent) occurred on a golf course. At the initial examination, visual acuity was 20/20 in four eyes (36 percent), 20/25 to 20/80 in three eyes (27 percent), no light perception in three eyes (27 percent) and undeterminable in one eye (9 percent) because of altered mental status.”
Injuries included orbital fracture (a break in the bones forming the eye socket) in 11 eyes (100 percent), hyphema or blood in the eye in four eyes (36 percent) and damage to the optic nerve in three eyes (27 percent). Nine of 11 patients (82 percent) required surgery. At the final follow-up visit, two eyes (18 percent) had no light perception and visual acuity was 20/70 in one eye (9 percent) and 20/20 or better in eight eyes (73 percent).
Most pediatric golf-related injuries do not appear to occur on the golf course or during supervised play, the authors note. “Most children are injured by other children wielding a golf club while at play away from the golf course,” they write. “The frequency of potentially devastating ocular and head trauma has been demonstrated in our series and in our review of the literature.”
“Increased public awareness may help to decrease morbidity from golf-related ophthalmic injuries to children,” they conclude. “We recommend close adult supervision, adequate separation between children and protective eyewear for children learning to play golf. Furthermore and most critically, golf equipment should be stored in a secure area away from children. Children should be taught that golf equipment should never be used without supervision. The efforts of ophthalmologists to prevent eye injures in other sports, notably hockey and baseball, have been successful and should serve as models to prevent golf-related ocular injuries in the pediatric population.”
(Arch Ophthalmol. 2008;126[9]:1252-1256. 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, September 8, 2008
Media Advisory: To contact corresponding author Daniel Finkelstein, M.D., M.A., call John M. Lazarou at 410-502-8902.
SURVEY FINDS SPIRITUALITY IS IMPORTANT TO EYE PATIENTS
CHICAGO—Patients visiting an ophthalmologist report that prayer is important to their well-being and that God plays a positive role in illness, according to a report in the September issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
“Ethical medical practice includes physician behavior, beyond technical competence, that promotes healing and optimizes the patient’s welfare,” the authors write as background information in the article. “The physician who respects the patient as a person with dignity must acknowledge the patient’s value system to establish a relationship that permits conversations that nourish trust for joint therapeutic decision making. For many patients, religion and spirituality is important to their value system and may represent a unique source of motivation and coping with life events, including the experience of personal illness (illness refers to the response of a patient to a disease).”
Gina Magyar-Russell, Ph.D., of the Johns Hopkins School of Medicine, Baltimore, and colleagues distributed a brief questionnaire to 124 patients visiting the office of one ophthalmologist. The 14-question survey was completed by the patient and collected without any identifying information, so patients could be assured the answers would not affect their care.
Of the participants:
- 76.6 percent were Christian, 5.6 percent Jewish and 3.2 percent agnostic
- 69.4 percent reported that prayer was very important to their sense of well-being and 12.9 percent that it was moderately important
- 45.2 percent attend religious services at least once per week
- 41.1 percent agreed that God permits illness but doesn’t cause it, and 54.8 percent believe God can influence a cure
- 58.1 percent report that God can directly help physicians treat illness
- 67.7 percent agree that God helps them be “at peace” with their illness
- Most believe either that illness is a way to make one stronger (32.3 percent) or that it is a mystery (36.3 percent) rather than a punishment from God (4 percent) or a test (22.6 percent)
“Christians were more likely to believe that God can influence cure than were Jewish and agnostic participants, and there was a trend toward Christians believing that God gives strength to be ‘at peace’ with illness compared with Jewish and agnostic participants,” the authors write. “Christians also reported more frequent religious and spiritual service attendance, and they rated prayer as more important than individuals reporting Jewish and agnostic belief systems.”
“The data obtained from this questionnaire suggest that patients’ expressions of religion and spirituality should be assessed and acknowledged by their ophthalmologist,” the authors write. “Obtaining a brief religious and spiritual history, when it becomes a routine part of developing a relationship between the patient and the physician, may become more comfortable for the physician with time, add to an understanding of the patient’s value system, provide the patient with a greater sense of trust in the physician and assist in the healing process, especially when a cure is not possible.”
(Arch Ophthalmol. 2008;126[9]:1262-1265. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Institutes of Health National Center for Complementary and Alternative Medicine (Dr. Magyar-Russell). 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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