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 PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 6, 2008)
USING A FAN DURING SLEEP ASSOCIATED WITH LOWER RISK OF SIDS
PEDIATRICIANS MORE LIKELY TO DISCLOSE MEDICAL ERRORS THAT ARE APPARENT TO FAMILIES, SURVEY FINDS
FLU VACCINE NOT ASSOCIATED WITH REDUCED HOSPITALIZATIONS OR OUTPATIENT VISITS AMONG YOUNG CHILDREN
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 6, 2008)
BIPOLAR DISORDER IN CHILDREN APPEARS LIKELY TO CONTINUE INTO YOUNG ADULTHOOD
INDIVIDUALS WITH SOCIAL PHOBIA SEE THEMSELVES DIFFERENTLY
STUDY EXAMINES HOW AND WHY SOME CHILDREN BECOME CHRONICALLY ABUSED BY PEERS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 6, 2008
Media Advisory: To contact corresponding author De-Kun Li, M.D., Ph.D., call Danielle Cass at 510-267-5354.
USING A FAN DURING SLEEP ASSOCIATED WITH LOWER RISK OF SIDS
CHICAGO—Fan use appears to be associated with a lower risk of sudden infant death syndrome (SIDS) in rooms with inadequate ventilation, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
The national incidence of SIDS decreased 56 percent from 1992 to 2003, according to background information in the article. This decline is largely attributed to the increased use of the supine sleep position (lying on the back with head facing up) after the introduction of the "Back to Sleep" campaign in 1994. In more recent years, the decrease in SIDS has leveled off. "Although caretakers should continue to be encouraged to place infants on their backs to sleep, other potentially modifiable risk factors in the sleep environment should be examined to promote further decline in the rate of SIDS." The association between room ventilation and SIDS risk is a factor that has not received sufficient attention. Inadequate room ventilation might facilitate the pooling of carbon dioxide around an infant's nose and mouth, increasing the likelihood of rebreathing. The movement of air in the room may potentially reduce the risk of SIDS.
Kimberly Coleman-Phox, M.P.H., and colleagues at Kaiser Permanente Northern California, Oakland, analyzed information from interviews of mothers of 185 infants who had died from SIDS and mothers of 312 randomly selected infants from the same county, maternal race/ethnicity and age. Mothers were asked about fan use, pacifier use, open window in the room at the infant's last sleep, room location, sleep surface, number and type of covers over the infant, bedding under the infant and room temperature.
Compared with infants who did not die from SIDS, at the last sleep, more infants who died from SIDS:
- were placed on their stomachs or sides (68.9 percent vs. 43.9 percent)
- did not use a pacifier (95.9 percent vs. 76.4 percent)
- were found with bedding or clothing covering the head (11.4 percent vs. 4.5 percent)
- slept on a soft surface (12.1 percent vs. 6.8 percent)
- shared a bed with someone other than a parent (14 percent vs. 5.5 percent)
The use of soft bedding underneath the infant and room temperature at last sleep were the same for both groups of children.
Having a fan on during sleep was associated with a 72 percent decrease in SIDS risk compared to sleeping in a room without a fan. Fan use in warmer room temperatures (above 21 degrees Celcius/69 degrees Fahrenheit) was associated with a 94 percent decreased risk of SIDS compared with no fan use. Fan use also was associated with a decreased risk of SIDS in infants who slept in the prone or side position, shared a bed with someone other than their parents or did not use a pacifier.
Despite the effectiveness of placing infants on their backs to sleep in lowering SIDS risk, approximately 25 percent of child care providers do not regularly follow this practice. "Use of the prone sleep position [lying with the front or face downward] remains highest in care providers who are young, black or of low income or who have low educational attainment," the authors conclude. "In this study, the frequency of fan use was similar in young and less educated women as in other women; thus, fan use can be easily adopted by these populations.
"Although improving the methods used to convey the importance of the supine sleep position remains paramount, use of a fan in the room of a sleeping infant may be an easily available means of further reducing SIDS risk that can be readily accepted by care providers from a variety of social and cultural backgrounds."
(Arch Pediatr Adoles Med. 2008;162[10]:963-968. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This project was supported by a contract from the National Institute of Child Health and Human Development and the National Institute on Deafness and Other Communication Disorders. Additional support was provided by a Kaiser CHR Fellowship. 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, October 6, 2008
Media Advisory: To contact David J. Loren, M.D., call Clare Hagerty at 206-685-1323. To contact editorialist Wendy Levinson, M.D., F.R.C.P.C., call Jennifer Little at 416-946-8423.
PEDIATRICIANS MORE LIKELY TO DISCLOSE MEDICAL ERRORS THAT ARE APPARENT TO FAMILIES, SURVEY FINDS
CHICAGO—A survey of pediatricians found wide variation in whether and how they reported they would disclose medical errors to patients and their families, and may be less likely to share information about errors that are less obvious to parents, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Parents want to be told when an error occurs in their child's care, but such disclosure does not always occur, according to background information in the article. "Disclosing an error to one or both parents, and possibly to the child as well, may prove to be an exceptionally challenging conversation," the authors write.
In a survey conducted by David J. Loren, M.D., of the University of Washington School of Medicine, Seattle, and colleagues, 205 pediatricians (out of 369, a 56 percent response rate) answered 11 questions about one of two scenarios. In the first, the pediatrician administered an overdose of insulin that resulted in the child's admission to the intensive care unit—an error deemed apparent to the family. The second scenario involved failure to follow up on a child's laboratory test, which resulted in an infection and hospitalization. This error was considered less obvious to parents.
A total of 176 pediatric attending physicians and 29 trainees responded to the survey. Of these:
- 161 (79 percent) described either error as serious, and 171 (83 percent) said they would feel very or extremely responsible
- 91 (44 percent) would be concerned that their reputation would be damaged by the error, and 69 (34 percent) believed it was likely to result in a lawsuit
- 109 (53 percent) would definitely disclose the error, 82 (40 percent) would probably do so and 14 (7 percent) would disclose only if asked by the parent
- 95 (46 percent) would use the word "error" when disclosing, 54 (26 percent) would include an explicit apology acknowledging the harm caused to the child and 103 (50 percent) would explain detailed plans for preventing future errors
- Compared with those who received the lab test scenario, twice as many who received the apparent error scenario would disclose the error (73 percent vs. 33 percent) and more would offer an explicit apology (33 percent vs. 20 percent)
Disclosing pediatric medical errors may be complicated because of the need to accommodate children's varying levels of understanding, the authors note. In addition, the view of children as helpless, the lack of information about how an error will affect long-term physical and intellectual development and the long statute of limitations for harm to a child may affect pediatricians' disclosure decisions.
"In conclusion, the relationship among a pediatrician, a child and a family is steeped in trust, a commodity that can be significantly diminished by the occurrence of a medical error," the authors write. "Nevertheless, parents have clearly articulated a desire to be told about errors in the medical care of their children. This study demonstrated marked variation in when and how pediatricians might disclose medical errors and found that they may be less likely to disclose an error that was less apparent to the family. Further research on the impact of professional guidelines and innovative educational interventions is warranted to help diminish the disparity between patient preferences for disclosure and current professional behavior."
(Arch Pediatr Adoles Med. 2008;162[10]:922-927. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Funding for this study was provided by grants from the Agency for Healthcare Research and Quality, the St. Louis Children's Hospital and the Seattle Children's Hospital and Regional Medical Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: PEDIATRICIANS CAN MOVE FROM TELLING HALF THE STORY TO FULL DISCLOSURE
"Overall, approximately half of respondents would definitely tell the patient [about an error], half would be explicit that an error occurred, half would disclose the details of the event and half would discuss how future errors could be prevented," writes Wendy Levinson, M.D., F.R.C.P.C., of the University of Toronto, in an accompanying editorial. "The bottom line is that the respondents tell about half of the truth rather than providing full disclosure."
"This is not owing to a failure by the pediatricians in this study, however," she continues. "There are many barriers to disclosure, including physicians' feelings of embarrassment or shame, fears of malpractice suits (a third of the pediatricians thought it likely that they would be sued for such an error) and discomfort in conducting these challenging disclosure conversations. Pediatricians have the additional challenge of having to discuss the error with parents who are protecting young and vulnerable children."
"Loren and colleagues have set the stage for pediatrics by providing survey results specific to the specialty," Dr. Levinson concludes. "Like other physician groups, pediatricians have an opportunity to improve their knowledge and skills about disclosing medical errors. They can move from telling half the story to full transparent disclosure, consistent with the expectations of our patients."
(Arch Pediatr Adoles Med. 2008;162[10]:991-992. 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, October 6, 2008
Media Advisory: To contact Peter G. Szilagyi, M.D., M.P.H., call Heather Hare at 585-273-2840.
FLU VACCINE NOT ASSOCIATED WITH REDUCED HOSPITALIZATIONS OR OUTPATIENT VISITS AMONG YOUNG CHILDREN
CHICAGO—Use of the influenza vaccine was not associated with preventing hospitalizations or reducing physician visits for the flu in children age 5 and younger during two recent seasons, perhaps because the strains of virus in the vaccine did not match circulating strains, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
Influenza causes substantial illness among young children; therefore, the United States and other countries have expanded their childhood vaccination requirements, according to background information in the article. As of June 2006, U.S. health officials recommend annual vaccinations for all children age 6 to 59 months. "An inherent assumption of expanded vaccination recommendations is that the vaccine is efficacious in preventing clinical influenza disease," the authors write.
Peter G. Szilagyi, M.D., M.P.H., of the University of Rochester School of Medicine and Dentistry and Strong Memorial Hospital, Rochester, N.Y., and colleagues studied 414 children age 5 and younger who developed influenza during the 2003-2004 or 2004-2005 seasons (245 seen in hospitals or emergency departments, and 169 seen in outpatient practices). Their vaccination status was compared with that of more than 5,000 children from the same three counties who did not have influenza during those seasons.
Before the researchers considered any other factors, children with influenza appeared to have lower vaccination rates than children without influenza. "However, significant influenza vaccine effectiveness could not be demonstrated for any season, age or setting after adjusting for county, sex, insurance, chronic conditions recommended for influenza vaccination and timing of influenza vaccination (vaccine effectiveness estimates ranged from 7 percent to 52 percent across settings and seasons for fully vaccinated 6- to 59-month olds)," the authors write.
A suboptimal match between the strain of influenza in the vaccine and that circulating in the public during those two seasons may have contributed to the poor effectiveness, the authors note. In 2003-2004, 99 percent of circulating influenza strains were caused by the influenza A virus, but only 11 percent of influenza A strains across the United States were similar to those in the vaccine. "The 2004-2005 season was less severe and the vaccine was a better match to circulating strains than in 2003-2004, but still only 36 percent of virus isolates were antigenically similar to vaccine strains," they write.
This study comparing cases with controls adds important information about vaccine effectiveness in children but should be combined with additional research, including studies of years with good vaccine match, they conclude. "Further studies of influenza vaccine effectiveness are needed using a variety of study designs (that adjust for confounders) to assess the yearly impact of influenza vaccination programs for children, particularly as higher rates of vaccination are achieved in the study population," the authors write.
(Arch Pediatr Adoles Med. 2008;162[10]:943-951. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was funded by the Centers for Disease Control and Prevention as part of the New Vaccine Surveillance Network and the National Vaccine Program Office, and some subjects in Cincinnati were recruited through a study funded by QuickVue Influenza Test (Quidel Corp., San Diego, Calif.). 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, October 6, 2008
Media Advisory: To contact Barbara Geller, M.D., call Jim Dryden at 314-286-0110. To contact editorialist Ellen Leibenluft, M.D., call the NIMH Press Office at 301-443-4536.
BIPOLAR DISORDER IN CHILDREN APPEARS LIKELY TO CONTINUE INTO YOUNG ADULTHOOD
CHICAGO—About 44 percent of individuals who had bipolar disorder as children continue to have manic episodes as young adults, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals. This rate, along with the severity of the disease at young ages, strongly suggest that bipolar disorder can be continuous from childhood to adulthood, the authors note.
Recent data has demonstrated an enormous increase in the diagnosis of pediatric bipolar disorder, a severe mood disorder involving episodes of mania and depression, according to background information in the article. However, skepticism continues to exist regarding the existence of the condition in children. Given increased media attention to the issue, there is a need to further increase the validity of childhood diagnoses.
Barbara Geller, M.D., and colleagues at Washington University in St. Louis studied 115 children (average age 11.1) diagnosed with bipolar disorder beginning in 1995 to 1998. At the beginning of the study and again during nine follow-up visits conducted over eight years, the children and their parents were interviewed separately about their symptoms, diagnoses, daily cycles of mania and depression and interactions with others.
A total of 108 (93.9 percent) of the children completed the study (average age at follow-up, 18.1 years). During the eight-year follow-up, they spent 60.2 percent of weeks with any mood episodes and 39.6 percent of weeks with episodes of mania. Although 87.8 percent recovered from mania, 73.3 percent relapsed. The researchers also examined the characteristics of children's second and third episodes of mania and found that like the first episodes, they were characterized by psychosis, daily cycling between mania and depression and a long duration (55.2 weeks for the second and 40 weeks for the third episode).
At the end of the follow-up period, 54 patients were age 18 or older. Of those, 44.4 percent continued to have manic episodes and 35.2 percent had substance use disorders, a rate similar to those diagnosed with bipolar disorder as adults.
"In grown-up subjects with child bipolar disorder I, the 44.4 percent frequency of manic episodes was 13 to 44 times higher than population prevalences, strongly supporting continuity between child and adult bipolar disorder I," the authors write. "Subjects with child bipolar disorder I who were grown up at the eight-year follow-up constituted approximately half the sample. However, even if all subjects younger than 18 years at the eight-year follow-up never had episodes of bipolar disorder I as adults, the overall significance of the findings would be similar, because the rate would still be six to 22 times higher than population prevalences."
"In conclusion, mounting data support the existence of child bipolar disorder I, and the severity and chronicity of this disorder argue strongly for large efforts toward understanding the neurobiology and for developing prevention and intervention strategies," they write.
(Arch Gen Psychiatry. 2008;65[10]:1125-1133. 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. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: EXAMINATION LAYS GROUNDWORK FOR FUTURE RESEARCH
"Extending previous seminal work on pediatric bipolar disorder, Geller et al present the first longitudinal study following up a large sample of youth diagnosed with pediatric bipolar disorder into adulthood," writes Ellen Leibenluft, M.D., of the National Institute of Mental Health, Bethesda, Md., in an accompanying editorial.
"Just as the children in this important study have matured over the last decade, so has research on pediatric bipolar disorder," Dr. Leibenluft writes. More articles on the condition were published in January 2008 than in the decade between 1986 and 1996.
"This upsurge both results from and contributes to a growing awareness that serious mental illnesses do not emerge de novo when individuals reach adulthood, but rather reflect early developmental processes. This awareness has profound implications for future research, highlighting the need for longitudinal studies such as that of Geller et al as well as pathophysiological research in children, studies comparing adults and youth with bipolar disorder and studies of youth at familial risk for bipolar disorder," Dr. Leibenluft concludes.
(Arch Gen Psychiatry. 2008;65[10]:1122-1124. 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, October 6, 2008
Media Advisory: To contact Karina Blair, Ph.D., call the NIMH Press Office at 301-443-4536.
INDIVIDUALS WITH SOCIAL PHOBIA SEE THEMSELVES DIFFERENTLY
MRI Reveals Altered Brain Response to Negative Comments
CHICAGO—Magnetic resonance brain imaging reveals that patients with generalized social phobia respond differently than others to negative comments about themselves, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Generalized social phobia is characterized by fear/avoidance of social situations and fear of being judged negatively by others," the authors write as background information in the article. "It is the most common anxiety disorder in the general population, with the lifetime prevalence estimated at 13.3 percent, and it is associated with a high risk for depression, alcohol and drug abuse and suicide." Previous studies have found differences in the way brains of affected individuals respond to facial expressions, suggesting that the condition involves increased responsiveness to social stimuli in areas linked to emotion.
Karina Blair, Ph.D., and colleagues at the National Institute of Mental Health, Bethesda, Md., compared functional MRI (fMRI) scans of 17 unmedicated individuals with generalized social phobia to those of 17 controls who were the same age and sex and had the same IQ but did not have the disorder. "During fMRI scans, individuals read positive (e.g., You are beautiful), negative (e.g., You are ugly) and neutral (e.g., You are human) comments that could be either about the self or about somebody else (e.g., He is beautiful)," the authors write.
The patients with generalized social phobia showed increased blood flow in their medial prefrontal cortex and amygdala—areas of the brain linked to concepts of self as well as fear, emotion and stress response—when reading negative statements about themselves. However, there were no differences between the two groups in response to negative comments referring to others or neutral or positive comments referring to either self or others.
"Given that medial prefrontal cortex regions are involved in representations of the self, it might be suggested that these regions, together with the amygdala, play a primary role in the development and maintenance of generalized social phobia and that the pathology in the disorder at least partly reflects a negative attitude toward the self, particularly in response to social stimuli—that in generalized social phobia what engages the mind is others' criticism," the authors conclude. "This highly context-dependent response in generalized social phobia helps constrain existing models of the disorder and may thus guide future therapeutic formulations in the treatment of the disorder."
(Arch Gen Psychiatry. 2008;65[10]:1176-1184. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was supported by the Intramural Research Program of the National Institutes of Health, National Institute of Mental 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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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 6, 2008
Media Advisory: To contact corresponding author Michel Boivin, Ph.D., e-mail michel.boivin{at}psy.ulaval.ca.
STUDY EXAMINES HOW AND WHY SOME CHILDREN BECOME CHRONICALLY ABUSED BY PEERS
CHICAGO—As soon as children are old enough to interact socially, some become entrenched in chronic and increasing patterns of victimization by their peers, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Children who are aggressive in infancy and are from families with harsh parenting styles and insufficient income appear more likely to be consistently victimized.
As many as one in 10 youth are the direct target of physical attacks, hostile words and social aggression from peers during school years, according to background information in the article. "Studies also show that peer victimization becomes increasingly stable over time, with the same children enduring such negative experiences throughout childhood and adolescence," the authors write. "The consequences associated with high and chronic victimization are manifold and include depression, loneliness, low self-esteem, physical health problems, social withdrawal, alcohol and/or drug use, school absence and avoidance, decrease in school performance, self-harm and suicidal ideation [thoughts and behaviors]."
Edward D. Barker, Ph.D., of the University of Alabama, Tuscaloosa, and colleagues studied 1,970 children (51 percent boys) born in Québec, Montreal, Canada, between October 1997 and July 1998. Participating children were assessed at ages 4.5 months, 16.6 months, and 2.4, 3.4, 4.1, 5.1, 6.2 and 7.2 years. At each point, mothers provided information on factors such as victimization, family adversity, parenting styles, physical aggression, hyperactivity and internalizing symptoms. At age 7.2 years, teachers and children reported on victimization by classmates.
"Three trajectory groups were identified with respect to victimization by peers between 3.4 and 6.2 years of age," the authors write. "As expected, most of the children (71 percent) fell on a low/increasing trajectory, whereas 25 percent and 4 percent of the children followed moderate/increasing and high/chronic trajectories, respectively. The overall age-related increase in preschool peer victimization is consistent with the view that, as preschool children progressively spend more time interacting with peers, they are more likely to experience negative peer experiences."
Children who were on the high/chronic and moderate/increasing trajectory according to their mothers' reports at young ages also had the highest levels of victimization at age 7.2, as reported by themselves and their teachers. Children who were aggressive at a young age (17 months) were more likely to become victims in preschool than children who were less aggressive, but neither early internalizing symptoms (for example, sadness, fear and anxiety) or hyperactivity were associated with later victimization. Children exposed to harsh parenting were more likely to be chronic victims, and insufficient family income also predicted high/chronic and moderate/increasing victimization trajectories.
In addition to identifying factors associated with victimization, "the present results also suggest that multiple forms of victimization may be the norm for victimized children, i.e., children with a high/chronic trajectory had harsh, reactive parents and were victimized by peers in preschool and after school entry. Other forms of victimization are likely to occur for these children, both within the school (e.g., verbal bullying by teachers) and within the community, particularly within low socioeconomic contexts," the authors write. "These results suggest that early preventive interventions should target both child- and parent-level risks and focus on alternatives to harsh and aggressive interactions."
(Arch Gen Psychiatry. 2008;65[10]:1185-1192. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This research was based on the Québec Longitudinal Study of Child Development and was supported by the Institute de la Statistique du Québec, the Québec Ministry of Health and Social Services, the Québec Ministry of Families and Seniors, the Canadian Institutes for Health Research, the Social Science and Humanities Research Council of Canada, the Québec Fund for Research on Society and Culture, the Québec Health Research Fund and the Canada Research Chair Program. Analyses were supported by a grant from the Medical Research Council, London. 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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