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, November 10, 2008)
GETTING LITTLE SLEEP MAY BE ASSOCIATED WITH RISK OF HEART DISEASE
LONG-TERM SECONDARY PREVENTION PROGRAM MAY HELP REDUCE CARDIOVASCULAR RISKS AFTER HEART ATTACK
ANTIBIOTIC USE INCREASES AT ACADEMIC MEDICAL CENTERS
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), November 10, 2008)
VISION SCREENING LAW FOR OLDER FLORIDIANS ASSOCIATED WITH LOWER FATALITY RATES IN CAR CRASHES
HIGH TEMPERATURES DECREASE ANTIFUNGAL PROPERTIES OF CONTACT SOLUTION IMPLICATED IN RECENT EYE INFECTION EPIDEMIC
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), November 10, 2008)
BRAIN IMAGING STUDY SUPPORTS THE "COGNITIVE RESERVE" HYPOTHESIS FOR WITHSTANDING ALZHEIMER'S DISEASE SYMPTOMS
ONLY HALF OF PATIENTS WITH MULTIPLE SCLEROSIS ACHIEVE AND MAINTAIN RESPONSE TO INTERFERON TREATMENT
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 10, 2008
Media Advisory: To contact Kazuo Eguchi, M.D., Ph.D., email ke112{at}jichi.ac.jp.
GETTING LITTLE SLEEP MAY BE ASSOCIATED WITH RISK OF HEART DISEASE
CHICAGO—Sleeping less than seven and a half hours per day may be associated with future risk of heart disease, according to a report in the November 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. In addition, a combination of little sleep and overnight elevated blood pressure appears to be associated with an increased risk of the disease.
"Reflecting changing lifestyles, people are sleeping less in modern societies," according to background information in the article. Getting adequate sleep is essential to preventing health conditions such as obesity and diabetes as well as several risk factors for cardiovascular disease including sleep-disordered breathing and night-time hypertension (high blood pressure).
Kazuo Eguchi, M.D., Ph.D., at Jichi Medical University, Tochigi, Japan, and colleagues monitored the sleep of 1,255 individuals with hypertension (average age 70.4) and followed them for an average of 50 months. Researchers noted patients' sleep duration, daytime and nighttime blood pressure and cardiovascular disease events such as stroke, heart attack and sudden cardiac death.
During follow-up, 99 cardiovascular disease events occurred. Sleep duration of less than 7.5 hours was associated with incident cardiovascular disease. "The incidence of cardiovascular disease was 2.4 per 100 person-years in subjects with less than 7.5 hours of sleep and 1.8 per 100 person-years in subjects with longer sleep duration," the authors write.
Patients with shorter sleep duration plus an overnight increase in blood pressure had a higher incidence of heart disease than those with normal sleep duration plus no overnight increase in blood pressure, but the occurrence of cardiovascular disease in those with a longer sleep duration vs. those with a shorter sleep duration was similar in those who did not experience an overnight elevation in blood pressure.
"In conclusion, shorter duration of sleep is a predictor of incident cardiovascular disease in elderly individuals with hypertension," particularly when it occurs with elevated nighttime blood pressure, the authors note. "Physicians should inquire about sleep duration in the risk assessment of patients with hypertension."
(Arch Intern Med. 2008;168[20]:2225-2231. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by grants-in-aid from the Foundation for the Development of the Community, Tochigi, Japan; the Banyu Fellowship Program, sponsored by Banyu Life Science Foundation International; and the National Heart, Lung and Blood Institute. 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 10, 2008
Media Advisory: To contact Pantaleo Giannuzzi, M.D., e-mail pantaleo.giannuzzi{at}fsm.it.
LONG-TERM SECONDARY PREVENTION PROGRAM MAY HELP REDUCE CARDIOVASCULAR RISKS AFTER HEART ATTACK
CHICAGO—An intensive, comprehensive, long-term secondary prevention program lasting up to three years after cardiac rehabilitation appears to reduce the risk of a second non-fatal heart attack and other cardiovascular events, according to a report in the November 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Cardiac rehabilitation programs after a heart disease diagnosis have evolved over two decades from solely exercise-based interventions, according to background information in the article. Now, rehabilitation includes helping patients with smoking cessation, diet, risk factors, and lifestyle habits. However, current rehabilitation procedures rely on short-term interventions that are unlikely to yield long-term benefits because patients never reach therapeutic goals.
Pantaleo Giannuzzi, M.D., of the Associazione Nazionale Medici Cardiologi Ospedalieri Research Center, Florence, Italy, and colleagues conducted the Global Secondary Prevention Strategies to Limit Event Recurrence After Myocardial Infarction (GOSPEL) study, in which they randomly assigned 1,620 patients who had a heart attack to receive a long-term, reinforced, multifactorial educational and behavioral intervention after a standard period of rehabilitation.
"The intervention was aimed at individualizing risk factor and lifestyle management, and pharmacological treatments were based on current guidelines," the authors write. Comprehensive sessions with one-on-one support were held monthly for six months, then once every six months for three years. Results of patients in this program were compared with those of 1,621 who were randomly assigned to receive usual care.
Overall, 556 patients (17.2 percent) experienced a cardiovascular event. The intervention did not significantly reduce the risk of combined heart events (which occurred in 261 [16.1 percent] of patients in the intervention group and 295 [18.2 percent] in the usual care group), including cardiovascular death, non-fatal heart attack, non-fatal stroke and hospitalization for chest pain, heart failure or an urgent revascularization procedure to restore blood flow. However, the program did significantly decrease incidence of individual heart events and some combinations of outcomes, including a 33 percent reduction in cardiovascular death plus non-fatal heart attack and stroke (3.2 percent in the intervention group vs. 4.8 percent in the usual care group), a 36 percent reduction in cardiac death plus non-fatal heart attack (2.5 percent vs. 4 percent) and a 48 percent reduction in non-fatal heart attack (1.4 percent vs. 2.7 percent).
"A marked improvement in lifestyle habits (i.e., exercise, diet, psychosocial stress, less deterioration of body weight control) and in prescription of drugs for secondary prevention was seen in the intervention group," the authors write.
"After three years, the integrated, multifactorial, reinforced approach proved effective in countering the risk factors and medication adherence deterioration over time and was able to induce a considerable improvement in lifestyle habits," the authors conclude. "In line with such results, all the clinical end points were reduced by the intensive intervention." The results reinforce previous findings that gains achieved with short-term cardiac rehabilitation are not maintained over time and suggest that a more comprehensive, sustained intervention is needed to reduce cardiovascular risks after a heart attack.
(Arch Intern Med. 2008;168[20]:2194-2204. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: The GOSPEL Study was supported by Società Prodotti Antibiotici with an unrestricted research grant. 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 10, 2008
Media Advisory: To contact corresponding author Ronald E. Polk, Pharm.D., call Malorie Janis at 804-827-0889.
ANTIBIOTIC USE INCREASES AT ACADEMIC MEDICAL CENTERS
CHICAGO—Antibacterial drug use appears to have increased at academic medical centers between 2002 and 2006, driven primarily by greater use of broad-spectrum agents and the antibiotic vancomycin, according to a report in the Nov. 10 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Using antibacterial drugs increases the risk that pathogens will become resistant to their effects, according to background information in the article. Infection with drug-resistant bacteria is associated with greater illness and death and higher health care costs than infection with bacteria susceptible to antibiotics. "Many professional societies and national agencies have recommended monitoring antibacterial use and linking patterns of use to resistance," the authors write.
Amy L. Pakyz, Pharm.D., M.S., of Virginia Commonwealth University, Richmond, and colleagues measured antibiotic use documented in claims data from university teaching hospitals between 2002 and 2006. In 2006 and 2007, pharmacists or physicians specializing in infectious diseases at 19 hospitals completed a 12-question survey about factors that may influence antimicrobial drug use, including whether the hospital had a stewardship program to reduce antibiotic use.
Data were available from 35 hospitals in 2006—that year, a total of 775,731 patients were discharged, with 492,721 (63.5 percent) receiving an antibacterial drug. Between 2002 and 2006, the average total antibacterial use at the 22 hospitals providing five-year data increased from 798 days of therapy per every 1,000 days patients were in the hospital to 855 per 1,000 patient-days in 2006.
When antibiotic use was examined by class, fluoroquinolones were the most commonly used, and their use remained constant. Five broad-spectrum antibiotic classes—those that act against a wide range of bacteria—increased significantly, driving the overall increase. "The other change contributing to the increase in total use was the marked increase in the use of vancomycin," the authors write. "During five years, the mean [average] vancomycin use increased by 43 percent," and this drug became the single most commonly used antibacterial in the hospitals studied between 2004 and 2006.
"With few new antibacterials in development, antimicrobial stewardship programs in concert with aggressive infection control efforts represent the best chance for control of resistant pathogens," the authors write. "Stopping antibacterials when they are not needed, switching to more narrow-spectrum drug regimens and optimal dosing using pharmacokinetic and pharmacodynamic principles [interactions between drugs and the body] are critical. Equally important will be investigations designed to identify shorter durations of antibacterial treatments for nosocomial [hospital-acquired] infections that have the potential to dramatically decrease antibacterial exposure."
(Arch Intern Med. 2008;168[20]:2254-2260. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded in part by an investigator-initiated grant from Bayer. 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 10, 2008
Media Advisory: To contact Gerald McGwin Jr., M.S., Ph.D., call Bob Shepard at 205-934-8934.
VISION SCREENING LAW FOR OLDER FLORIDIANS ASSOCIATED WITH LOWER FATALITY RATES IN CAR CRASHES
CHICAGO—A vision screening law targeting Florida drivers age 80 and older appears to be associated with lower death rates from motor vehicle collisions in this age group, despite little evidence of an association between vision and car crashes, according to a report in the November issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
"Older drivers represent the fastest-growing segment of the driving population," the authors write as background information in the article. "As this segment of the population expands, so too have public safety concerns, given older drivers' increased rate of motor vehicle collision involvement per mile driven. Research has suggested that this increase may be partly attributed to medical, functional and cognitive impairments."
Little evidence links visual acuity to involvement in motor vehicle collisions. However, in January 2004, Florida implemented a law requiring all drivers 80 years and older to pass a vision test before renewing their driver's licenses. Gerald McGwin Jr., M.S., Ph.D., and colleagues at the University of Alabama at Birmingham used data from the National Highway Traffic Safety Administration and the U.S. Census Bureau to study rates of motor vehicle collision deaths among all drivers and older drivers in Florida between 2001 and 2006. They also compared these rates to those in Alabama and Georgia, neighboring states that did not change their legal requirements during this time period.
Overall death rates from motor vehicle collisions in Florida increased non-significantly between 2001 and 2006, but showed a linear decrease in drivers age 80 and older. When comparing the period before the law (2001 to 2003) to the period after the law (2004 to 2006), the fatality rate among all drivers increased by 6 percent (from 14.61 per 100,000 persons per year to 14.75 per 100,000) while fatality rates among older drivers decreased by 17 percent (from 16.03 per 100,000 persons per year to 10.76 per 100,000). Death rates among older drivers did not change in Alabama or Georgia during the same time period.
Several potential reasons exist for the decline in Florida, the authors note. "Perhaps the most apparent reason is that the screening law removed visually impairment drivers from the road," the authors write. "However, in reality, the situation is significantly more complex."
About 93 percent of individuals who sought a license renewal were able to obtain one, suggesting that only a small percentage of drivers were removed from the road for failing to meet the vision standards. Another possibility is that the vision screening requirement improved visual function overall, because many of those who do not pass the test on the first try seek vision care and then return with improved vision. Finally, those who believe they have poor vision may have been discouraged from renewing their license at all, voluntarily removing themselves from the road.
"Ultimately, whether the vision screening law is responsible for the observed reduction in fatality rates because of the identification of visually impaired drivers or via another, yet related, mechanism may be inconsequential from a public safety perspective," the authors write. "However, the importance of driving to the well-being of older adults suggests that isolating the true mechanism responsible for the decline is in fact important." Future research identifying this mechanism would allow states to implement laws that accurately target high-risk drivers while allowing low-risk older drivers to retain their mobility.
(Arch Ophthalmol. 2008;126[11]:1544-1547. 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, November 10, 2008
Media Advisory: To contact John D. Bullock, M.D., M.P.H., M.Sc., call Cindy Young at 937-775-2951 or Phillip Neal at 937-775-4587.
HIGH TEMPERATURES DECREASE ANTIFUNGAL PROPERTIES OF CONTACT SOLUTION IMPLICATED IN RECENT EYE INFECTION EPIDEMIC
CHICAGO—Exposure to prolonged temperature elevation reduces antifungal activity of a contact lens solution that was implicated in the epidemic of the eye infection Fusarium keratitis that occurred between 2004 and 2006, according to a report in the November issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Bausch & Lomb introduced ReNu with MoistureLoc, which contains an antimicrobial agent not found in other solutions, in August 2004, according to background information in the article. The first cases of Fusarium keratitis related to ReNu with MoistureLoc were reported to the U.S. government in March 2006; total of 154 confirmed cases were identified in the United States. "Bausch & Lomb investigators acknowledged that all original cases appear to be related to ReNu with MoistureLoc produced in their Greenville, S.C., plant," the authors write.
According to the article, in 2006, the Food and Drug Administration (FDA) inspected this facility and cited Bausch & Lomb for inadequate temperature control in the production, storage and transport of products produced there. To assess what effect temperature might have on the growth of Fusarium fungus, John D. Bullock, M.D., M.P.H., M.Sc., of the Wright State University Boonshoft School of Medicine, Dayton, Ohio, and colleagues studied six contact solutions, including ReNu with MoistureLoc. "Two bottles of each solution were separately stored at room temperature and 60 degrees Celsius [140 degrees Fahrenheit] for four weeks, serially diluted and then tested for their ability to inhibit growth of 11 Fusarium isolates (seven of which were associated with the keratitis epidemic)," the authors write.
After the 60-degree storage, ReNu with MoistureLoc demonstrated the greatest decline in anti-fungal activity, while Clear Care and ReNu MultiPlus performed the best. When considering just the strains of Fusarium associated with the keratitis epidemic, ReNu with MoistureLoc that was stored at room temperature allowed fungal growth in 27 of 84 combinations (different blends of isolates grown in different solutions and at different levels of dilution), compared with 67 of 84 combinations for the bottle stored at 140 degrees Fahrenheit.
"The precise temperature, duration of exposure to elevated temperature and extent of temperature fluctuation that may diminish the antimicrobial activity of a particular contact lens solution is not known, and thus, additional studies may be warranted. However, our findings, coupled with the FDA reports of Bausch & Lomb's failure to regulate the storage and transport temperatures of the products manufactured in their Greenville plant, may be significant," the authors conclude.
"Knowledge of the potential loss of antimicrobial activity of contact lens solutions and other pharmaceutical products when exposed to higher temperatures and the risk of such exposure when storing and transporting those products may help prevent such epidemics in the future."
(Arch Ophthalmol. 2008;126[11]:1493-1498. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: Dr. Bullock has served as a consultant for three different law firms concerning the Fusarium keratitis epidemic. The compensation was paid to the Wright State University Foundation and not to Dr. Bullock. No outside funding from any source was provided for this study. Any and all costs associated with this research study were paid for by the authors personally or by CompuNet Clinical Laboratories. 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 10, 2008
Media Advisory: To contact Catherine M. Roe, Ph.D., call Michael Purdy at 314-286-0122.
BRAIN IMAGING STUDY SUPPORTS THE "COGNITIVE RESERVE" HYPOTHESIS FOR WITHSTANDING ALZHEIMER'S DISEASE SYMPTOMS
CHICAGO— Individuals with higher education levels appear to score higher on cognitive tests despite having evidence of brain plaques associated with Alzheimer's disease, according to a report in the November issue of Archives of Neurology, one of the JAMA/Archives journals.
The cognitive reserve hypothesis holds that individuals with greater cognitive (thinking, learning and memory) abilities are able to delay symptoms of Alzheimer's disease despite underlying changes in the brain, according to background information in the article. Education is commonly used as a substitute measure of cognitive reserve. "Adjusting for level of Alzheimer disease pathological burden determined at autopsy, greater education has been associated with better cognitive function during life," the authors write. "Education interacts with Alzheimer disease pathological burden such that a greater pathological burden is required to show an effect on cognition among persons with more education."
Catherine M. Roe, Ph.D., and colleagues at the Washington University School of Medicine, St. Louis, studied 37 individuals with dementia of the Alzheimer type and 161 individuals without dementia between 2003 and 2008. Participants reported their education history and took cognitive tests. They were injected with a marker known as carbon 11—labeled Pittsburgh Compound B ([11C]PiB) and then underwent a 60-minute positron emission tomography (PET) scan of the brain. Recent studies have shown that [11C]PiB adheres to beta-amyloid brain plaques associated with Alzheimer's disease, allowing researchers to identify these characteristics of the disease in living patients.
The level of [11C]PiB uptake interacted significantly with years of education in predicting cognitive test scores. Among individuals whose brains took up higher levels of [11C]PiB, indicating the presence of beta-amyloid plaques, performance on the test increased with increasing education levels. Education was not associated with cognitive scores among those with low [11C]PiB uptake, indicating no plaques.
"The results support the hypothesis that cognitive reserve influences the association between Alzheimer disease pathological burden and cognition," the authors write. "Based on autopsy data, there may be a ceiling effect when extensive beta-amyloid pathological burden is present as in late-stage dementia of the Alzheimer type. Presumably, as the Alzheimer disease pathological burden increases, a greater proportion of highly educated participants reaches the threshold for dementia and the initial advantage provided by cognitive reserve decreases. Longitudinal imaging of beta-amyloid pathology in vivo will soon allow us to determine whether these inferences from cross-sectional studies are accurate."
(Arch Neurol. 2008;65[11]:1467-1471. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by grants from the National Institute on Aging and the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Md., and by the Charles and Joanne Knight Alzheimer's Research Initiative of the Washington University Alzheimer's Disease Research Center. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 10, 2008
Media Advisory: To contact corresponding author Francesca Bagnato, M.D., Ph.D., call Dan Stimson or Margo Warren at 301-496-5924.
ONLY HALF OF PATIENTS WITH MULTIPLE SCLEROSIS ACHIEVE AND MAINTAIN RESPONSE TO INTERFERON TREATMENT
CHICAGO—Regular magnetic resonance imaging (MRI) evaluations show that only about half of patients with multiple sclerosis achieve and sustain a response to treatment with interferon beta over three years, according to a study posted online today that will appear in the January 2009 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Before they develop symptoms of a relapse, patients with multiple sclerosis (MS) develop contrast-enhancing brain lesions that are visible on MRI, according to background information in the article. Worsening of the disease is presumed to follow these relapses. "Many clinical studies have demonstrated the ability of interferon beta to reduce contrast-enhancing lesions," the authors write. "However, little is known regarding the heterogeneity of the MRI response profiles between patients or within an individual patient over time."
Annie W. Chiu, B.S., and colleagues at the National Institute of Neurological Disorders and Stroke, Bethesda, Md., assessed 15 patients with MS who underwent monthly MRIs and clinical examinations during a six-month pretreatment phase and a 36-month treatment phase. During treatment, patients receive injections of 250 micrograms of interferon beta under the skin every other day.
Eight patients (53.3 percent) achieved a 60 percent reduction in the number of lesions at each six-month period and were therefore classified as responders. Of the seven non-responders, three (20 percent) initially experienced a reduction in the total number of lesions but then did not experience further reductions, two (13.3 percent) never reached the 60 percent level of reduction and two (13.3 percent) failed to respond during the first six months but reached and maintained an optimal reduction in lesions of 60 percent or more thereafter. Three patients in the responder group and all seven patients in the non-responder group experienced at least one clinical exacerbation during the treatment phase.
"To our knowledge, our descriptive study provides for the first time a detailed long-term analysis of MRI patterns of patients undergoing long-term interferon beta-1b therapy," the authors conclude. "The results show that on close monthly MRI inspection, approximately half of the patients fail therapy from an MRI perspective."
"Also, we show that an additional small proportion of patients may not be necessarily recognized as MRI non-responders during the first semester [six months] of therapy, and frequent radiological monitoring is advised during the first year of therapy. Multiple MRIs, beyond the first six months of therapy, also disclose a small proportion of patients with a delayed but eventually sustained response to interferon beta and provide compelling information regarding the clinical outcome of patients during the course of a longer trial."
(Arch Neurol. 2009;66[1]:(doi:10.1001/archneur.66.1.noc80047. 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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