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 NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 13, 2008)
DRINKING ALCOHOL ASSOCIATED WITH SMALLER BRAIN VOLUME
VITAMIN D DEFICIENCY MAY BE MORE COMMON IN PARKINSON’S DISEASE PATIENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 13, 2008)
MEN WHO NEVER SMOKE LIVE LONGER, BETTER LIVES THAN HEAVY SMOKERS
STUDY EXAMINES ASSOCIATION BETWEEN CAFFEINE CONSUMPTION AND BREAST CANCER RISK
CANCER SCREENING RATES AMONG OLDER MEDICAID PATIENTS FALL SHORT OF NATIONAL OBJECTIVES
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 13, 2008)
COMBINATION OF SUNLIGHT EXPOSURE, LOW ANTIOXIDANT LEVELS MAY PLACE OLDER ADULTS AT RISK FOR EYE DISEASE
VISION LOSS MORE COMMON IN PEOPLE WITH DIABETES
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 13, 2008
Media Advisory: To contact Carol Ann Paul, M.S., call Arlie Corday at 781-283-3321.
DRINKING ALCOHOL ASSOCIATED WITH SMALLER BRAIN VOLUME
CHICAGO— The more alcohol an individual drinks, the smaller his or her total brain volume, according to a report in the October issue of Archives of Neurology, one of the JAMA/Archives journals.
Brain volume decreases with age at an estimated rate of 1.9 percent per decade, accompanied by an increase in white matter lesions, according to background information in the article. Lower brain volumes and larger white matter lesions also occur with the progression of dementia and problems with thinking, learning and memory. Moderate alcohol consumption has been associated with a lower risk of cardiovascular disease; because the brain receives blood from this system, researchers have hypothesized that small amounts of alcohol may also attenuate age-related declines in brain volume.
Carol Ann Paul, M.S., of Wellesley College, Mass., and colleagues studied 1,839 adults (average age 60) who were part of the Framingham Offspring Study, which began in 1971 and includes children of the original Framingham Heart Study participants and their spouses. Between 1999 and 2001, participants underwent magnetic resonance imaging (MRI) and a health examination. They reported the number of alcoholic drinks they consumed per week, along with their age, sex, education, height, body mass index and Framingham Stroke Risk Profile (which calculates stroke risk based on age, sex, blood pressure and other factors).
"Most participants reported low alcohol consumption, and men were more likely than women to be moderate or heavy drinkers," the authors write. "There was a significant negative linear relationship between alcohol consumption and total cerebral brain volume."
Although men were more likely to drink alcohol, the association between drinking and brain volume was stronger in women, they note. This could be due to biological factors, including women’s smaller size and greater susceptibility to alcohol’s effects.
"The public health effect of this study gives a clear message about the possible dangers of drinking alcohol," the authors write. "Prospective longitudinal studies are needed to confirm these results as well as to determine whether there are any functional consequences associated with increasing alcohol consumption. This study suggests that, unlike the associations with cardiovascular disease, alcohol consumption does not have any protective effect on brain volume."
(Arch Neurol. 2008;65[10]:1363-1367. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a contract from the National Heart, Lung, and Blood Institute’s Framingham Heart Study, National Institutes of Health; grants from the National Institute on Aging; and a grant from the National Institute of Neurological Disorders and Stroke. 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 13, 2008
Media Advisory: To contact Marian L. Evatt, M.D., M.S., call Jennifer Johnson at 404-727-5696.
VITAMIN D DEFICIENCY MAY BE MORE COMMON IN PARKINSON’S DISEASE PATIENTS
CHICAGO—Individuals with Parkinson’s disease appear more likely to be vitamin D deficient than healthy adults of the same age or patients with Alzheimer’s disease, according to a report in the October issue of Archives of Neurology, one of the JAMA/Archives journals.
"Vitamin D is important for maintaining many physiologic functions, and vitamin D deficiency is associated with increased risk of disease," according to background information in the article. "Patients with chronic neurodegenerative diseases frequently have many risk factors for vitamin D insufficiency," including advancing age, obesity, avoidance of sun exposure, residence in northerly latitudes and having darker skin.
Marian L. Evatt, M.D., M.S., and colleagues at the Emory University School of Medicine, Atlanta, compared vitamin D levels of 100 patients with Parkinson’s disease to vitamin D levels of 97 Alzheimer’s disease patients and 99 healthy individuals matched for age, sex, race, genotype and geographic location.
"Significantly more patients with Parkinson’s disease (55 percent) had insufficient vitamin D than did controls (36 percent) or patients with Alzheimer’s disease (41 percent)," the authors write. The average vitamin D concentration in the group with Parkinson’s disease was considerably lower than the Alzheimer’s disease and healthy groups (31.9 nanograms per milliliter vs. 34.8 nanograms per milliliter and 37 nanograms per milliliter, respectively).
"These findings support the previously suggested need for further studies to assess what contribution a low 25(OH)D [a measure of blood vitamin D levels] concentration adds to the risk of developing Parkinson’s disease (vs. other neurodegenerative disorders) and to determine whether correction of vitamin D insufficiency and deficiency will improve motor or non-motor symptoms in Parkinson’s disease," the authors conclude.
"Finally, the finding of a high incidence of vitamin D deficiency in the Parkinson’s disease and other cohorts highlights the importance of routinely checking the level of 25(OH)D, particularly in elderly patients, since deficiency is strongly correlated with a higher incidence of osteoporosis, falls and hip fractures and has been associated with a higher incidence of several forms of cancer and autoimmune disorders."
(Arch Neurol. 2008;65[10]:1348-1352. 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, October 13, 2008
Media Advisory: To contact Arto Y. Strandberg, M.D., e-mail arto.strandberg{at}kolumbus.fi. To contact editorialist David M. Burns, M.D., call 858-794-8547.
MEN WHO NEVER SMOKE LIVE LONGER, BETTER LIVES THAN HEAVY SMOKERS
Other studies in Archives of Internal Medicine focus on smoking cessation strategies
CHICAGO—Health-related quality of life appears to deteriorate as the number of cigarettes smoked per day increases, even in individuals who subsequently quit smoking, according to a report in the October 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Smoking has been shown to shorten men’s lives between seven and 10 years, according to background information in the article. It also has been linked to factors that may reduce quality of life, including poor nutrition and lower socioeconomic status.
Arto Y. Strandberg, M.D., of the University of Helsinki, and colleagues followed 1,658 white men born between 1919 and 1934 who were healthy at their first assessment, conducted in 1974. Participants were mailed follow-up questionnaires in 2000 that assessed their current smoking status, health and quality of life. Deaths were tracked through Finnish national registers.
During the 26-year follow-up period, 372 (22.4 percent) of the men died. Those who had never smoked lived an average of 10 years longer than heavy smokers (more than 20 cigarettes per day). Non-smokers also had the best scores on all health-related quality of life measures, especially those associated with physical functioning. Physical health deteriorated at an increasing rate as the number of cigarettes smoked per day increased, with heavy smokers experiencing a decline equivalent to 10 years of aging.
"Although many smokers had quit smoking between the baseline investigation in 1974 and the follow-up examination in 2000, the effect of baseline smoking status on mortality and the quality of life in old age remained strong," the authors write. "In all, the results presented here are troubling for those who were smoking more than 20 cigarettes daily 26 years earlier; in spite of the 68.9 percent cessation rate during follow-up, 44.1 percent of the originally heavy smokers had died, and those who survived to the mean [average] age of 73 years had a significantly lower physical health-related quality of life than never-smokers."
The findings may add to the view of smoking as a burden on society and might also encourage individual smokers to quit, the authors note. "The argument of better quality of life may be especially meaningful for the aging smoker but, as our results show, for the best health-related quality of life, the habit should not be started at all," they write. "The highly addictive nature of nicotine is revealed by the persistence of the smoking habit in spite of the declining health-related quality of life among older heavy smokers. For those not able to quit smoking, reduction may also be beneficial because mortality [death] and health-related quality of life showed a dose-dependent trend according to the number of cigarettes smoked daily."
Additional papers related to smoking in the October 13 issue found that:
- Offering smoking cessation counseling to hospitalized smokers appears to be effective as long as supportive contacts are offered for more than one month after discharge. Nancy A. Rigotti, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues reviewed 33 trials of smoking cessation interventions that began during hospitalizations. Programs that offered telephone or in-person support lasting longer than one month improved smoking cessation rates six to 12 months after discharge. "Adding nicotine replacement therapy to counseling may further increase smoking cessation rates and should be offered when clinically indicated, especially to hospitalized smokers with nicotine withdrawal symptoms," the authors write.
- Hospital-based smoking cessation programs, along with referrals to cardiac rehabilitation, also appear to be associated with increased rates of quitting smoking following heart attack. Nazeera Dawood, M.D., M.P.H., at Emory University School of Medicine, Atlanta, and colleagues studied 639 patients who smoked at the time of their hospitalization for myocardial infarction (heart attack). Six months later, 297 (46 percent) had quit smoking. The odds of quitting were greater among patients who received discharge recommendations for cardiac rehabilitation and those who were treated at a facility offering an inpatient smoking cessation program; however, individual counseling was not associated with quit rates.
- A pay-for-performance program may increase referrals to tobacco quitline services, particularly among clinics who have not previously participated in quality improvement activities. Lawrence C. An, M.D., of the University of Minnesota, Minneapolis, and colleagues randomly assigned 24 primary care clinics to participate in a program offering $5,000 for 50 quitline referrals. Between Sept. 1, 2005, and June 31, 2006, these clinics referred 11.4 percent of eligible smokers, compared with 4.2 percent among 25 clinics offering usual care. "Quitlines are widely available, and application of pay-for-performance strategies to encourage health care provider referral should be strongly considered by health care organizations seeking to reduce the health and economic burden of tobacco-related disease," the authors write.
"Smoking remains the largest avoidable cause of death and disability in the United States, but it is a problem against which we are making steady albeit far too slow progress," writes David M. Burns, M.D., Del Mar, Calif., in an accompanying editorial. "Smoking cessation is one of the most important changes needed to achieve the goal so often articulated by Dr. Ernst Wynder, one of the founders of the field of preventive medicine: die young as late in life as possible."
(Arch Intern Med. 2008;168[18]:1968-1974, 1950-1960, 1961-1967, 1993-1999, 1946-1947.. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Please see the articles for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. To contact Nancy A. Rigotti, M.D., call Emily Parker at 617-724-6425. To contact corresponding author Susmita Parashar, M.D., M.P.H., M.S., call Jennifer Johnson at 404-727-5696. To contact Lawrence C. An., M.D., call Nick Hanson at 612-624-2449.
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 13, 2008
Media Advisory: To contact corresponding author Shumin M. Zhang, M.D., Sc.D., call Lori J. Shanks at 617-534-1604.
STUDY EXAMINES ASSOCIATION BETWEEN CAFFEINE CONSUMPTION AND BREAST CANCER RISK
CHICAGO—Caffeine consumption does not appear to be associated with overall breast cancer risk, according to a report in the October 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. However, there is a possibility of increased risk for women with benign breast disease or for tumors that are hormone-receptor negative or larger than 2 centimeters.
Caffeine is probably the most commonly consumed drug worldwide, present in coffee, tea, chocolate and some medications, according to background information in the article. It was hypothesized that caffeine may increase the risk of breast cancer after a study showed that women with non-cancerous breast disease experienced relief from their symptoms after removing caffeine from their diet.
Ken Ishitani, M.D., Ph.D., of Brigham and Women’s Hospital and Harvard Medical School, Boston, and Tokyo Women’s Medical University, Japan, and colleagues studied 38,432 women 45 years or older who provided dietary information in 1992-1995. Over an average of 10 years of follow-up, 1,188 of the women developed invasive breast cancer.
"Consumption of caffeine and caffeinated beverages and foods was not statistically significantly associated with overall risk of breast cancer," the authors write. Among women with benign breast disease, a non-significant positive association with breast cancer risk was observed for those in the highest quintile (one-fifth) of caffeine consumption and a significant association was observed for those in the highest category of coffee consumption (four cups or more daily).
Consuming caffeine was also associated with a 68 percent increased risk of estrogen receptor–negative and progesterone receptor–negative breast cancer, or tumors to which the hormones estrogen and progesterone do not bind, and a 79 percent increased risk for breast tumors larger than 2 centimeters.
"The mechanisms by which caffeine may affect breast carcinogenesis [cancer development] are complex and remain unclear," the authors write. "In the present investigation, caffeine consumption was associated with increased risk of breast cancers negative for both estrogen receptors and progesterone receptors or larger than 2 centimeters, which have less favorable prognoses. These findings indicate that caffeine consumption may affect breast cancer progression, and such an effect may be independent of the estrogen pathway." Further study is required to better understand caffeine’s role, they note.
(Arch Intern Med. 2008;168[18]:2022-2031. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by research 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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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 13, 2008
Media Advisory: To contact C. Annette DuBard, M.D., M.P.H., call Brad Deen at 919-733-9190.
CANCER SCREENING RATES AMONG OLDER MEDICAID PATIENTS FALL SHORT OF NATIONAL OBJECTIVES
CHICAGO—Only about half of Medicaid recipients age 50 and older appear to receive recommended screening tests for colorectal, breast and cervical cancer, according to a report in the October 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
These three types of cancer are potentially curable when detected early, and eliminating disparities in screenings is part of the government’s Healthy People 2010 plan, according to background information in the article. "State Medicaid agencies are in a unique position to monitor and improve the quality of care received by some of the nation’s most vulnerable citizens," the authors write. "Medicaid is the largest provider of health insurance for minority populations in America. Medicaid recipients, by virtue of Medicaid eligibility criteria, frequently share other characteristics associated with health-related disparities: low income, old age, and/or chronic disability because of advanced disease, physical limitation, severe mental illness or developmental disability."
C. Annette DuBard, M.D., M.P.H., of the North Carolina Department of Health and Human Services, Raleigh, and the University of North Carolina at Chapel Hill, and colleagues studied a representative sample of 1,951 North Carolina Medicaid recipients age 50 and older. Medical records were reviewed to determine whether physicians had recommended and patients had received cancer screening examinations.
"Documentation that colorectal, breast and cervical cancer screening was recommended by the primary care provider was found for only 52.7 percent, 60.4 percent and 51.5 percent of eligible patients, respectively," the authors write. "Documented rates of adequate screening were 28.2 percent for colorectal cancer, 31.7 percent for mammography within two years and 31.6 percent for Papanicolaou [cervical cancer] test within three years. When medical record and claims data were combined, approximately half of eligible patients had evidence of screening."
Despite Medicaid recipients’ access to primary care and full coverage of cancer screening services, these rates are substantially lower than those in the general population, the authors note. "Lack of a screening recommendation by the physician, rather than patient refusal of recommended tests, accounted for most instances of screening delinquency," they conclude. "Efforts to increase cancer screening rates among Medicaid recipients must address patient, physician and organizational barriers to the routine identification and delivery of preventive services."
(Arch Intern Med. 2008;168[18]:2014-2021. 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, October 13, 2008
Media Advisory: To contact Astrid E. Fletcher, Ph.D., e-mail astrid.fletcher{at}lshtm.ac.uk.
COMBINATION OF SUNLIGHT EXPOSURE, LOW ANTIOXIDANT LEVELS MAY PLACE OLDER ADULTS AT RISK FOR EYE DISEASE
CHICAGO—A European study suggests that the combination of low plasma levels of antioxidants and blue light exposure from the sun is associated with certain forms of the eye disease age-related macular degeneration (AMD), according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
"The retina is vulnerable to the damaging effects of light," the authors write as background information in the article. "While wavelengths in the UV radiation range are largely absorbed by the cornea and lens, the retina is exposed to visible light, including blue light." Animal and laboratory studies suggest blue light may damage the retina and contribute to the development of AMD, which occurs when the area of the retina (macula) responsible for sharp vision deteriorates.
Antioxidant enzymes—including vitamins C and E, the carotenoids (lutein and zeaxanthin) and zinc—may protect against the harmful effects of blue light on the retina. Astrid E. Fletcher, Ph.D., of the London School of Hygiene & Tropical Medicine, and colleagues measured levels of these nutrients in the blood of 4,753 older adults (average age 73.2) who were part of the European Eye Study. Participants also were interviewed about their lifetime sunlight exposure and had photographs taken of their retinas to detect AMD.
Of the 4,400 participants with complete information available, 2,117 did not have AMD, 101 had neovascular (advanced, involving the formation of new blood vessels) AMD and 2,182 had early-stage AMD. Overall, there was no association between blue light exposure and neovascular or early AMD. However, blue light exposure was associated with neovascular AMD in the one-fourth of individuals with lowest antioxidant levels. "In particular, the combination of blue light exposure in the presence of low levels of zeaxanthin, alpha-tocopherol [vitamin E] and vitamin C was associated with a nearly four-fold odds ratio of neovascular AMD," the authors write.
Key recommendations from the results include ensuring the intake of key antioxidants, which can be accomplished by consuming recommended dietary intake levels of vitamin C and zinc and increasing consumption of carotenoid-rich fruits and vegetables, the authors note. In addition, individuals should take steps to reduce the exposure of the retina to blue light, such as wearing broad-brimmed hats and sunglasses when outdoors.
"In the absence of cost-effective screening methods to identify people in the population with early AMD, we suggest that recommendations on ocular protection and diet target the general population, especially middle-aged people," they conclude.
(Arch Ophthalmol. 2008;126[10]:1396-1403. 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, October 13, 2008
Media Advisory: To contact Xinzhi Zhang, M.D., Ph.D., call the CDC Division of Media Relations at 404-639-3286.
VISION LOSS MORE COMMON IN PEOPLE WITH DIABETES
CHICAGO—Visual impairment appears to be more common in people with diabetes than in those without the disease, according to a report in the October issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Approximately 14.6 million Americans had diagnosed diabetes mellitus in 2005 and another 6.2 million had undiagnosed diabetes, according to background information in the article. It is estimated that the number of individuals with diagnosed diabetes will increase to 48.3 million by 2050. "Diabetic retinopathy [damage to the retina caused by diabetes], one of the most common microvascular complications of diabetes, is considered to be one of the major causes of blindness and low vision," the authors write. Although studies suggest that controlling glucose and blood pressure have reduced the rate of retinal diseases, other ocular conditions suffered by diabetic patients, such as cataract and glaucoma, may increase the risk of visual impairment. Additionally, decreased vision caused by an abnormal shape of the cornea is also common among people with diabetes.
Xinzhi Zhang, M.D., Ph.D., and colleagues at the Centers for Disease Control and Prevention, Atlanta, used data from the National Health and Nutrition Examination Surveys from 1999 to 2004, which included 1,237 adults with diabetes (average age 59) and 11,767 adults without the disease (average age 45) and also measured their visual acuity before and after optical correction. Participants’ vision was tested while they were wearing any glasses or contacts they typically used, and their demographic information was also noted.
An estimated 11 percent of American adults with diabetes had some form of visual impairment (3.8 percent uncorrectable and 7.2 percent correctable), while only 5.9 percent of those without diabetes had some form of visual impairment (1.4 percent uncorrectable and 4.5 percent correctable). "People with diabetes were more likely to have uncorrectable vision impairment than those without diabetes, even after controlling for selected other factors," the authors write. "Our findings also suggest a strong association between visual impairment (correctable and uncorrectable) and older age, member of racial/ethnic minorities, lower income and lack of health insurance, all independent of diabetes status."
"The high prevalence of visual impairment among people with diabetes indicates a need for diverse public health strategies to reduce the burden of both correctable and uncorrectable visual impairment," the authors conclude. "It is important to identify and pursue ways to increase access to eye care for everyone and to correct visual impairment, where possible, to diminish morbidity and mortality due to impaired vision."
(Arch Ophthalmol. 2008;126[10]:1421-1427. 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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