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, November 3, 2008)
PRECIPITATION LEVELS MAY BE ASSOCIATED WITH AUTISM
PARENTS' WARTIME DEPLOYMENT ASSOCIATED WITH CHILDREN'S BEHAVIOR PROBLEMS
LIVING WITH SMOKERS MAY BE ASSOCIATED WITH INADEQUATE ACCESS TO FOOD
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 3, 2008)
PTSD SYMPTOMS ASSOCIATED WITH INCREASED RISK OF DEATH AFTER HEART EVENTS
MRI REVEALS RELATIONSHIP BETWEEN DEPRESSION AND PAIN
RATES OF PSYCHOSIS HIGHER AMONG MINORITY GROUPS IN BRITAIN
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 3, 2008
To contact corresponding author Sean Nicholson, Ph.D., call Nicola Wendy Pytell at 607-254-6236. To contact editorialist Noel S. Weiss, M.D., Dr.P.H., call Mary Guiden at 206-616-3192.
PRECIPITATION LEVELS MAY BE ASSOCIATED WITH AUTISM
CHICAGO—Children living in counties with higher levels of annual precipitation appear more likely to have higher prevalence rates of autism, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. The results raise the possibility that an environmental trigger for autism may be associated with precipitation and may affect genetically vulnerable children.
In the past 30 years, autism rates have increased from approximately one in 2,500 to one in 150 children, according to background information in the article. Some of the increase is likely due to more active monitoring and changes in diagnostic criteria. "Nevertheless, the possibility of a true increase in prevalence cannot be excluded," the authors write. "Despite the increase in prevalence and the resulting increased attention paid to the condition, knowledge about what causes autism is limited. It is understood that biological factors play an important role, but environmental triggers may also be important."
Michael Waldman, Ph.D., of Cornell University, Ithaca, N.Y., and colleagues obtained autism prevalence rates from state and county agencies for children born in California, Oregon and Washington between 1987 and 1999. Using daily precipitation reports from the National Climatic Data Center, they calculated average annual rainfall by county from 1987 through 2001—which spans the dates when the children were school-aged.
"Autism prevalence rates for school-aged children in California, Oregon and Washington in 2005 were positively related to the amount of precipitation these counties received from 1987 through 2001," the authors write. "Similarly, focusing on Oregon and California counties with a regional center, autism prevalence was higher for birth cohorts that experienced relatively heavy precipitation when they were younger than 3 years." This corresponds to the time at which autism symptoms usually appear and when any post-natal environmental factors would be present.
Several potential explanations exist for the positive association, the authors note. Precipitation may be associated with more indoor activities, such as television and video viewing, that affect behavioral and cognitive development. The increased amount of time spent indoors also may expose children to more harmful chemicals, such as those in cleaning products, or decrease their exposure to sunshine, which helps the body produce vitamin D. "Finally, there is also the possibility that precipitation itself is more directly involved," the authors write. "For example, there may be a chemical or chemicals in the upper atmosphere that are transported to the surface by precipitation."
Because there is no direct clinical evidence of an environmental trigger for autism that is associated with precipitation, the results are preliminary, the authors note. However, "further research focused on establishing whether such as trigger exists and on identifying it is warranted," they conclude.
(Arch Pediatr Adoles Med. 2008;162[11]:1026-1034. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by unrestricted research grants from Cornell University. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: FINDINGS TENTATIVE BUT WORTH PUBLISHING
"As Waldman et al indicate, one can conceive that precipitation or its consequences (such as increased television watching, reduced vitamin D levels and enhanced exposure to indoor chemicals) might increase the incidence of autism," writes Noel S. Weiss, M.D., Dr.P.H., of the University of Washington, Seattle, in an accompanying editorial. "However, there are other possible explanations for the association with precipitation that they have observed."
"First, the criteria used to diagnose autism, and the completeness with which such diagnoses are identified by state agencies and regional centers, likely vary to a considerable extent across counties," Dr. Weiss continues. "Second, as is true in many cross-population comparisons, there may be unmeasured correlates of precipitation—beyond the consequences of precipitation—that bear on the occurrence of autism that themselves differ across counties."
"Of course, if a study's findings are no more than tentative ones—certainly, those of Waldman et al must be viewed as tentative—responsible authors will stress this," Dr. Weiss concludes. "In this instance, I believe that Waldman et al have indeed reported their results responsibly. They have made it clear that the message the public should take from their data regarding precipitation and autism is the same one suggested by an editorialist commenting on a recently observed modest association between prenatal exposure to cell phone use and behavior problems in childhood: 'No call for alarm, stay tuned'."
(Arch Pediatr Adoles Med. 2008;162[11]:1095-1096. 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, November 3, 2008
Media Advisory: To contact Molinda M. Chartrand, M.D., call Gina DiGravio at 617-638-8491. To contact corresponding editorialist David J. Schonfeld, M.D., call Jim Feuer at 513-636-4656.
PARENTS' WARTIME DEPLOYMENT ASSOCIATED WITH CHILDREN'S BEHAVIOR PROBLEMS
CHICAGO—Children ages 3 to 5 with a parent deployed to a war zone appear to exhibit more behavior problems than their peers whose parents are not deployed, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
More than 2 million U.S. children have had parents deployed to Iraq or Afghanistan during the wars there, according to background information in the article. About 40 percent of these children are younger than 5. "Recent policy statements from the American Psychological Association and the Department of Defense Task Force on Mental Health have called for research on the effect of wartime deployments on children in military families," the authors write.
Molinda M. Chartrand, M.D., of the Boston University School of Medicine and Boston Medical Center, and colleagues studied 169 families with children age 1½ to 5 who were enrolled in military childcare centers at a large Marine base in 2007. Parents and childcare providers each completed a behavior problem assessment that analyzed both internalizing (such as anxiousness, depression and withdrawal) and externalizing (such as attention problems and aggression) behaviors in the children. Parents also completed a questionnaire to measure their own level of depression. Caregivers provided information about the rank and deployment status of the parent in the service, as well as family composition and both parents' age, education and ethnicity.
Of the 169 families, 55 (33 percent) had a deployed parent, with an average deployment length of 3.9 months. Children age 3 and older who had a deployed parent had significantly higher scores on measures of externalizing and overall behavior problems than children of the same age without a deployed parent. "Such reported differences might be dismissed as distorted perceptions of the child by the distressed non-deployed parent; however, the association remained after controlling for parental stress and depressive symptoms," the authors write. In addition, childcare providers reported similarly elevated scores.
"Larger, longitudinal studies are needed to ascertain whether there are changes in children's behavior from the time before parental deployment, during parental deployment and at the time of reunification," the authors write. "This information is necessary to provide clinicians serving military families with evidence-based anticipatory guidance and clinical interventions. Finally, the needs of the children of deployed parents in the National Guard and Reserves also warrant urgent further elucidation."
(Arch Pediatr Adoles Med. 2008;162[11]:1009-1014. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Joel and Barbara Alpert Foundation and the Society for Developmental and Behavioral Pediatrics. Support in the form of books was provided by Reach Out and Read. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: CHANGES IN POLICY AND SERVICES NEEDED
"The decision to send troops into war is never taken lightly, and the sacrifices experienced by the soldiers, their families and their country are heavy burdens that may be considered intrinsic to war itself," write David J. Schonfeld, M.D., and Robin Gurwitch, Ph.D., of the Cincinnati Children's Hospital Medical Center, in an accompanying editorial. "However, our country's policies must be based on efforts to take all reasonable steps to minimize known negative effects; thus, these research results, which are unlikely to be surprising to pediatricians and other child health care providers, are nonetheless timely and important."
"Findings from this study highlight the need for increased attention to the mental health concerns of young children of deployed soldiers as well as the mental health concerns of the soldiers and non-deployed spouses," they continue. "They raise questions of how to best determine deployment length and what preventive measures can be taken to reduce stress and distress to the non-deployed spouses and children left behind."
(Arch Pediatr Adoles Med. 2008;162[11]:1094-1095. 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, November 3, 2008
Media Advisory: To contact Cynthia Cutler-Triggs, M.D., call Lorinda Klein at 212-404-3555.
To contact editorialist Frank J. Chaloupka, Ph.D., call Sherri McGinnis González at 312-996-8277.
LIVING WITH SMOKERS MAY BE ASSOCIATED WITH INADEQUATE ACCESS TO FOOD
CHICAGO—Children and adults living with adult smokers appear less likely to have daily access to enough healthy food compared with those living with non-smoking adults, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
About 13 million U.S. children live in food-insecure households, according to background information in the article. "Food insecurity is the inability to access enough food in a socially acceptable way for every day of the year. In households with the most severe food insecurity, there are multiple involuntary reductions in food intake and disruptions of usual eating patterns." Studies have shown that food insecurity is strongly associated with household income. Since families with at least one smoker spend 2 percent to 20 percent of their income on tobacco, it is likely that smokers are affecting the financial resources needed to provide adequate food.
Cynthia Cutler-Triggs, M.D., of the New York University School of Medicine and Bellevue Hospital Center, and colleagues analyzed 8,817 households with children age 17 and younger from 1999 to 2002 to see if the presence or absence of adult smokers in the household affected the food security of those living in the home. Age, sex, race of the child and poverty index ratios were also noted.
At least one smoker lived in 23 percent of the children's households "and 32 percent of children in low-income households lived with a smoker compared with 15 percent of those in more affluent households." Fifteen percent of adults and 11 percent of children reported having experienced food insecurity within the last year, with 6 percent of adults and 1 percent of children experiencing severe food insecurity.
"Food insecurity was more common and severe in children and adults in households with smokers," the authors write. "Of children in households with smokers, 17 percent were food insecure vs. 8.7 percent in households without smokers," with rates of severe child food insecurity at 3.2 percent and 0.9 percent, respectively. "For adults, 25.7 percent in households with smokers and 11.6 percent in households without smokers were food insecure, and rates of severe food insecurity were 11.8 percent and 3.9 percent, respectively." The highest rates of food insecurity were in children living in low-income households with smokers. Additionally, compared with white families, black and Hispanic families had higher rates of child food insecurity in both smoking and non-smoking homes.
"These data also demonstrate how pervasive this combination of child health risks is in low-income families," the authors conclude. "The burden of food insecurity is a previously unrecognized danger of adult tobacco use to be added to the ever-growing list of negative effects of adult tobacco use on children in the United States."
(Arch Pediatr Adoles Med. 2008;162[11]:1056-1062. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the American Academy of Pediatrics Julius B. Richmond Center of Excellence (Drs. Fryer and Weitzman and Mr. Miyoshi) and the Flight Attendant Medical Research Institute. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: SMOKING CESSATION COULD INCREASE HOUSEHOLD RESOURCES AVAILABLE FOR SPENDING ON FOOD
Aside from spending resources on cigarettes instead of healthy foods, cigarette smoking also contributes to "lost productivity resulting from diseases caused by smoking," further lowering incomes and raising the likelihood of food insecurity, writes Frank J. Chaloupka, Ph.D., of the University of Illinois at Chicago, in an accompanying editorial.
"Comprehensive tobacco control policies and programs are effective in reducing this burden, with higher taxes on cigarettes and other tobacco products being particularly effective in promoting cessation and reducing tobacco use in low-income populations," Dr. Chaloupka continues.
"However, the potential for higher taxes to exacerbate food insecurity in households that continue to smoke makes it critical that at least some of the new revenues generated by higher tobacco taxes be used to support programs targeting low-income households, including those that further reduce the health and economic burden caused by smoking on this particularly vulnerable population. "
(Arch Pediatr Adoles Med. 2008;162[11]:1096-1097. 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, November 3, 2008
Media Advisory: To contact Karl-Heinz Ladwig, Ph.D., M.D., e-mail
ladwig{at}helmholtz-muenchen.de.
PTSD SYMPTOMS ASSOCIATED WITH INCREASED RISK OF DEATH AFTER HEART EVENTS
CHICAGO—Individuals who receive implantable cardiac defibrillators after a sudden heart event appear more likely to die within five years if they experience symptoms of post-traumatic stress disorder, regardless of the severity of their disease, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
Surviving a life-threatening heart condition, such as heart attack or cardiac arrest, causes significant distress, according to background information in the article. Resulting symptoms—including intense fear, painful intrusive memories and hyperarousal (a state of physical and psychological tension resulting from the flight-or-fight response)—may qualify an individual for a diagnosis of post-traumatic stress disorder (PTSD). Between 8 percent and 20 percent of patients with acute coronary syndromes and 27 percent to 38 percent of those who survive a cardiac arrest develop PTSD.
Karl-Heinz Ladwig, Ph.D., M.D., of Technische Universitaet Muenchen, Munich, and Helmholtz Zentrum National Research Center for Environmental Health, Neuherberg, Germany, and colleagues studied 211 patients who had received implantable cardiac defibrillators (devices that administer shocks to help restore normal heartbeat) following a heart event in 1998. Participants were surveyed an average of 27 months after implantation and 38 reported severe PTSD symptoms. All patients were then tracked through medical records, telephone interviews, reports from family members and death certificates through March 2005.
During the average follow-up period of five years, 45 of the patients (30.6 percent) died. This included 32 of the 109 patients with low or moderate PTSD symptoms and 13 of 38 patients with high levels of such symptoms. "Our findings provide direct evidence for an independent influence of PTSD symptoms on fatal outcome in these patients," the authors write. "Experiencing PTSD symptoms conferred a 2.4-fold long-term age- and sex-adjusted mortality [death] risk for patients with implantable cardiac defibrillators."
Patients with PTSD in the study reported more cardiac symptoms, such as chest pain, than those without PTSD. However, clinical characteristics that typically account for survival differences in such patients—for example, the frequency at which their defibrillator administers shocks—did not differ between the two groups. "Therefore, the perceived severity rather than the objective severity of a cardiac condition as determined by cardiac criteria may be associated with PTSD," the authors write.
"Further investigations are required to assess the behavioral and biologic pathways by which posttraumatic maladaptation contributes to the excess mortality risk in patients with implantable cardiac defibrillators," they continue. One possible explanation is that medical recommendations for cardiac care—including drug prescriptions—may act as "traumatic reminders" for patients with PTSD and may therefore be ignored or avoided.
"The findings underline the urgent need for routinely applied comprehensive and interdisciplinary psychosocial aftercare for patients with implantable cardiac defibrillators," the authors conclude. "Although the serious mortality risk of PTSD in patients with implantable cardiac defibrillators needs to be further investigated before firm recommendations can be made, screening for PTSD symptoms in patients with implantable cardiac defibrillators is likely to be clinically beneficial, and treatment in selected patients should be attempted."
(Arch Gen Psychiatry. 2008;65[11]:1324-1330. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by a grant from the Deutsche Forschungsgemeinschaft. The psychosomatic ICD research unit was initially supported by an unrestricted educational grant from Boston Scientific Guidant. 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, November 3, 2008
Media Advisory: To contact Irina A. Strigo, Ph.D., call Debra Kain at 619-543-6163.
MRI REVEALS RELATIONSHIP BETWEEN DEPRESSION AND PAIN
MRI Reveals Altered Brain Response to Negative Comments
CHICAGO—The brains of individuals with major depressive disorder appear to react more strongly when anticipating pain and also display altered functioning of the neural network that modifies pain sensitivity, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
"Chronic pain and depression are common and often overlapping syndromes," the authors write as background information in the article. Recurring or chronic pain occurs in more than 75 percent of patients with depression, and between 30 percent and 60 percent of patients with chronic pain report symptoms of depression "Understanding the neurobiological basis of this relationship is important because the presence of comorbid pain contributes significantly to poorer outcomes and increased cost of treatment in major depressive disorder."
Irina A. Strigo, Ph.D., of the University of California San Diego, La Jolla, and colleagues studied 15 young adults with major depressive disorder (average age 24.5) who were not taking medication and 15 individuals who were the same age (average 24.3 years) and had the same education level but did not have depression. Patients with depression completed a questionnaire that evaluated their tendencies to magnify, ruminate over or feel helpless in the face of pain. All participants underwent functional magnetic resonance imaging (fMRI) while their arms were exposed to a thermal device heated to painful levels (an average of 46.4 degrees to 46.9 degrees Celsius, or about 115 degrees to 116 degrees Fahrenheit) and also to non-painful temperatures. Visual cues (a green shape for non-painful warmth and a red shape for painful warmth) were presented before the heat was applied.
Compared with the controls, patients with depression showed increased activation in certain areas of their brain—including the right amygdala—during the anticipation of painful stimuli. They also displayed increased activation in the right amygdala and decreased activation in other areas, including those responsible for pain modulation (adjusting sensitivity to pain), during the painful experience.
To examine whether the activation of the amygdala was associated with passive coping styles, the researchers compared the percentage change in the activations of the amygdala with the helplessness, rumination and ramification reported by the participants with depression. "Significant positive correlations were observed in the major depressive disorder group between greater helplessness scores and greater activity in the right amygdala during the anticipation of pain," the authors write.
"The anticipatory brain response may indicate hypervigilance to impending threat, which may lead to increased helplessness and maladaptative modulation during the experience of heat pain," the authors write. "This mechanism could in part explain the high comorbidity of pain and depression when these conditions become chronic."
"Future studies that directly examine whether maladaptive response to pain in major depressive disorder is due to emotional allodynia [a pain response to a non-painful stimulus], maladaptive control responses, lack of resilience and/or ineffectual recruitment of positive energy resources will further our understanding of pain-depression comorbidity," they conclude.
(Arch Gen Psychiatry. 2008;65[11]:1275-1284. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by Barrow Neurological Foundation, grants from the National Institute of Mental Health, the National Association for Research in Schizophrenia and Depression and the University of California San Diego Center of Excellence for Stress and 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, November 3, 2008
Media Advisory: To contact Jeremy W. Coid, M.D., e-mail
j.w.coid{at}qmul.ac.uk.
RATES OF PSYCHOSIS HIGHER AMONG MINORITY GROUPS IN BRITAIN
CHICAGO—Both first- and second-generation immigrants to the United Kingdom appear to have a higher risk of psychoses than white British individuals, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals.
An elevated risk for psychoses—psychiatric disorders such as schizophrenia that are characterized by a disconnect from reality—have been observed among migrant groups since 1932, when Norwegians moving to the United States displayed higher rates, according to background information in the article. "Immigration is an important life event and difficulties in assimilation may remain chronic as conceptualized within the stress-vulnerability model of risk for psychosis, although individual risk is still considered to be mediated through genetic susceptibility," the authors write.
Jeremy W. Coid, M.D., of St. Bartholomew's Hospital, London, and colleagues studied 484 patients in three inner-city boroughs of East London who first developed psychoses between 1996 and 2000. The patients, age 18 to 64, provided information about their self-described ethnicity, place of birth, and the place where their parents were born. Participants fell into six ethnic subgroups: white British, white other (including Irish and European), black Caribbean, black African, Asian (including Indian, Pakistani and Bangladeshi group) and all other groups (including Chinese, other Asian and those of mixed ethnicity).
"Raised incidence of both non-affective [not related to emotion or mood] and affective psychoses were found for all of the black and minority ethnic subgroups compared with white British individuals," the authors write. "The risk of non-affective psychoses for first and second generations varied by ethnicity." For example, black Caribbean second-generation immigrants were at higher risk for psychoses than their first-generation counterparts. Asian women of both generations, but not men, also had an increased risk compared with white British individuals.
The differences in psychosis rates between generations for some ethnic groups was likely due to age, the authors note. "The black Caribbean group provides an illustration of this: first- and second-generation immigrants were both at significantly greater risk for non-affective psychoses than the white British group, but the magnitude of this risk was significantly greater in the second generation; this is principally because first-generation black Caribbean immigrants have now largely passed through the main period of risk of psychoses," they write.
Several main factors associated with immigration may also be associated with psychoses, including discrimination, isolation and alienation, the authors note. "Our results suggest that given the same age structure, the risk of psychoses in first and second generations of the same ethnicity will be roughly equal," they write. "We suggest that socioenvironmental factors operate differentially by ethnicity but not generation status, even if the exact specification of these stressors differs across generations. Research should focus on differential rates of psychoses by ethnicity rather than between generations."
(Arch Gen Psychiatry. 2008;65[11]:1250-1258. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded by grants from St. Bartholomew's Hospital and the Royal London Hospital Special Trustees and East London and the City Mental Health NHS Trust R&D. 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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