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 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, June 10, 2008)
JAMA NEWS RELEASES
ST. JOHN’S WORT DOES NOT APPEAR EFFECTIVE FOR TREATING ADHD IN CHILDREN AND TEENS
USE OF BRIGHT LIGHTING IN SENIOR CARE FACILITIES ASSOCIATED WITH SOME IMPROVEMENT IN DEMENTIA SYMPTOMS
FOR HOSPITALIZED HEART FAILURE PATIENTS, CERTAIN FINDINGS ON ELECTROCARDIOGRAM PREDICTIVE OF RISK OF REHOSPITALIZATION AND DEATH
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
ST. JOHN’S WORT DOES NOT IMPROVE SYMPTOMS OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Video News Report is on treating ADHD in children and teens with the herb St. John’s wort. The report will be fed Tuesday, June 10, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 10, 2008
Media Advisory: To contact Wendy Weber, N.D., Ph.D., M.P.H., call Richelle Nielsen at 425-602-3107. To contact editorial author Eugenia Chan, M.D., M.P.H., call Bess Andrews at 617-919-3103.
ST. JOHN’S WORT DOES NOT APPEAR EFFECTIVE FOR TREATING ADHD IN CHILDREN AND TEENS
CHICAGO—Children and teens with attention-deficit/hyperactivity disorder (ADHD) who were treated with the herb St. John’s wort did not have any greater improvement in ADHD symptoms compared to those who received placebo, according to a study in the June 11 issue of JAMA.
ADHD affects 3 to 12 percent of children in the United States. Up to 30 percent of these children do not respond to pharmaceutical medications or have adverse effects such as nausea, insomnia, or weight loss from the medications, according to background information in the article. “For these reasons, many parents seek complementary or alternative medicine for their children with ADHD. Complementary or alternative medicine treatments used for pediatric ADHD include massage, dietary changes, dietary supplements, and herbal treatments. In the United States, the most common herbal treatments used by children with ADHD are St John’s wort, Echinacea species, and Ginkgo biloba,” the authors write.
Wendy Weber, N.D., Ph.D., M.P.H., of Bastyr University, Kenmore, Wash., and colleagues conducted a clinical trial of St. John’s wort (Hypericum perforatum) with 54 children and adolescents with ADHD, age 6 to 17 years, to determine whether this agent was effective in lessening the severity of ADHD symptoms. Twenty-seven participants were randomly assigned to receive 300 mg of H perforatum standardized to 0.3 percent hypericin (a compound derived from H perforatum) and 27 participants received a matched placebo, three times daily for eight weeks. Other medications for ADHD were not allowed during the trial.
The researchers found that there were no significant differences between the two groups in the change in ADHD rating scale scores from the start of the trial to week 8 and in change in scores rating inattentiveness and hyperactivity. There was also no difference in the proportion of participants who were rated as much or very much improved regarding ADHD symptoms on another measurement scale. No statistically significant difference was found between the two groups in the proportion of participants who experienced 1 or more rash, nausea/vomiting, headache, or sunburn during the trial.
“To our knowledge, this is the first placebo-controlled trial of H perforatum in children and adolescents. The results of this study suggest that administration of H perforatum has no additional benefit beyond that of placebo for treating symptoms of child and adolescent ADHD,” the authors write.
(JAMA. 2008;299[22]:2633-2641. Available pre-embargo to the media 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.
EDITORIAL: QUALITY OF EFFICACY RESEARCH IN COMPLEMENTARY AND ALTERNATIVE THERAPIES
In an accompanying editorial, Eugenia Chan, M.D., M.P.H., of Children’s Hospital Boston and Harvard Medical School, writes that conducting randomized controlled trials of complementary and alternative therapies can pose challenges.
“...randomizing participants may be difficult or impossible when the therapy to be evaluated relies on participants’ belief in the treatment or relationship with the practitioner. Use of placebo and blinding may be difficult in therapies such as acupuncture, yoga, psychotherapy, or surgery, although techniques such as placebo needles that do not actually enter the skin have been developed. Even when a plausible placebo can be used, placebo and expectation effects can be very large in both complementary and alternative medicine and conventional interventions and may be part of the mechanism of treatment efficacy.”
(JAMA. 2008;299[22]:2685-2686. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 10, 2008
Media Advisory: To contact corresponding author Eus J. W. Van Someren, Ph.D., email: e.van.someren{at}nin.knaw.nl.
USE OF BRIGHT LIGHTING IN SENIOR CARE FACILITIES ASSOCIATED WITH SOME IMPROVEMENT IN DEMENTIA SYMPTOMS
CHICAGO—The use of daytime bright lighting to improve the circadian rhythm of elderly persons was associated with modest improvement in symptoms of dementia, and the addition of the use of melatonin resulted in improved sleep, according to a study in the June 11 issue of JAMA.
“In elderly patients with dementia, cognitive decline is frequently accompanied by disturbances of mood, behavior, sleep, and activities of daily living, which increase caregiver burden and the risk of institutionalization,” the author write. These symptoms have been associated with disturbances of the circadian rhythm (the regular recurrence, in cycles of about 24 hours, of biological processes or activities). “The circadian timing system is highly sensitive to environmental light and the hormone melatonin and may not function optimally in the absence of their synchronizing effects. In elderly patients with dementia, synchronization may be [diminished] if light exposure and melatonin production are reduced.”
Rixt F. Riemersma-van der Lek, M.D., of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, and colleagues conducted a trial at 12 elderly group care facilities in the Netherlands that evaluated the effects of up to 3.5 years of daily supplementation of bright light and/or melatonin on a number of health outcomes, including symptoms of dementia and sleep disturbances. The study included 189 facility residents, average age 85.8 years; 90 percent were female and 87 percent had dementia.
Six of the facilities had bright lighting installed in ceiling-mounted fixtures. Lights were on daily between approximately 9 a.m. to 6 p.m. Participants were randomized to receive evening melatonin (2.5 mg) or placebo and participated an average of 15 months (maximum period of 3.5 years).
The researchers found that bright light lessened cognitive deterioration by a relative 5 percent, reduced depressive symptoms by a relative 19 percent and diminished the gradual increase in functional limitations by a relative 53 percent.
Melatonin reduced the time to fall asleep by a relative 19 percent and increased total sleep duration by 6 percent, but adversely affected caregiver ratings of withdrawn behavior and mood expressions. The addition of bright light improved the adverse effect on mood. In combination with bright light, melatonin reduced aggressive behavior by a relative 9 percent.
“In conclusion, the simple measure of increasing the illumination level in group care facilities [improved] symptoms of disturbed cognition, mood, behavior, functional abilities, and sleep. Melatonin improved sleep, but its long-term use by elderly individuals can only be recommended in combination with light to suppress adverse effects on mood. The long-term application of whole-day bright light did not have adverse effects, on the contrary, and could be considered for use in care facilities for elderly individuals with dementia,” the authors write.
(JAMA. 2008;299[22]:2642-2655. Available pre-embargo to the media 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 10, 2008
Media Advisory: To contact corresponding author Mihai Gheorghiade, M.D., call Marla Paul at 312-503-8928.
FOR HOSPITALIZED HEART FAILURE PATIENTS, CERTAIN FINDINGS ON ELECTROCARDIOGRAM PREDICTIVE OF RISK OF REHOSPITALIZATION AND DEATH
CHICAGO—Among patients hospitalized with heart failure, having a longer than normal QRS duration (a measurement of the electrical conducting time of the heart on an electrocardiogram (ECG)] appears to predict a high risk of death or rehospitalization within a few months after discharge, according to a study in the June 11 issue of JAMA.
An ECG is routinely obtained on all patients admitted with heart failure. Hospitalization for heart failure is a major public health problem in the developed world, with the United States and Europe each reporting more than 1 million heart failure hospitalizations per year. The frequency and the predictive value of a prolonged QRS duration during an admission for heart failure has not been well studied. Establishing the prognostic value of a prolonged QRS duration during hospitalization for heart failure may aid in tailoring therapy to improve postdischarge morbidity and mortality, according to background information.
Mihai Gheorghiade, M.D., and Norman C. Wang, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and investigators with the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) trial, investigated the relationship of QRS duration and changes during the course of hospitalization to outcomes such as death and hospitalization for heart failure. The study included 4,133 patients hospitalized for heart failure and having a left ventricular ejection fraction (LVEF; a measure of how well the left ventricle of the heart pumps with each contraction) of 40 percent or less. After excluding 1,029 patients with a pacemaker, implantable cardioverter-defibrillator, or both at enrollment and 142 patients without a reported baseline QRS duration, 2,962 patients were included in this analysis: 1,641 had a normal QRS duration (less than 120 ms) and 1,321 had a prolonged QRS duration (120 ms or greater). Median (midpoint) follow-up time was 9.9 months.
There were 678 total deaths (307 of 1,641 patients [18.7 percent] with a normal baseline QRS duration and 371 of 1,321 [28.1 percent] with a prolonged baseline QRS duration). The most common cause of death was heart failure followed by sudden cardiac death. The composite of cardiovascular death or hospitalization for heart failure was more frequent in patients with a prolonged baseline QRS duration at 3 months after enrollment (21.1 percent vs. 14.6 percent) and at the end of the follow-up period of 9.9 months (41.6 percent vs. 32.4 percent). After adjusting for multiple variables, compared with normal baseline QRS duration, prolonged QRS duration was associated with a 24 percent increased risk of death and a 28 percent increased risk for the composite of cardiovascular death or hospitalization for heart failure.
“In this analysis, a prolonged QRS duration was present in 45 percent of patients admitted with heart failure and reduced LVEF, did not appear to significantly change during hospitalization, and was independently associated with high postdischarge mortality and readmission rate. This high morbidity and mortality was observed even though patients were well-treated with standard medical therapy that included beta-blockers and angiotensin-converting enzyme [ACE] inhibitors or angiotensin II receptor blockers [ARBs],” the authors write.
“Measurement of the QRS duration on an ECG has significant advantages as a tool in the clinical setting. It is relatively inexpensive, simple to perform, and yields an instant result. The measurement is objective and does not require specialized training to interpret. In addition, the QRS duration is stable in the majority of patients during the course of their hospitalization. Perhaps most important, a prolonged QRS duration becomes a potential target for intervention [with existing therapy], which may improve postdischarge mortality and morbidity.”
(JAMA. 2008;299[22]:2656-2666. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Wang is now with the University of Pittsburgh Medical 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
ST. JOHN’S WORT DOES NOT IMPROVE SYMPTOMS OF ATTENTION-DEFICIT HYPERACTIVITY DISORDER
INTRO:
Attention-deficit hyperactivity disorder also known as A-D-H-D affects thousands of children each year. Up to thirty percent do not respond to prescription medication or may experience an adverse reaction to certain drugs. Herbal supplements are often considered by some parents looking for a way to help their children. One of the most popular is St. John’s Wort. But a new study finds it does not improve A-D-H-D symptoms. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Teen with ADHD walking
Pictures from childhood
AUDIO:
ADRIANA ARJONA (R-hone-ah) WAS DIAGNOSED WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER WHEN SHE WAS SIX YEARS OLD. HAVING TROUBLE CONCENTRATING AND ALWAYS FIDGETING SHE OFTEN FELT SHE DIDN’T FIT IN WITH OTHERS.
VIDEO:
SOT/FULL
Super @:15
Adriana Arjona
Diagnosed with A.D.H.D.
Runs: 08
AUDIO:
“They treated me a little differently and sometimes it was a little harder to fit in with people because you know I wasn’t like them. I always had the need to move.”
VIDEO:
B-ROLL
3 shot with teen, mom and doctor
Tight hands fidgeting
St. John’s Wort pills
AUDIO:
EVEN TODAY SHE STILL STRUGGLES WITH SYMPTOMS. LIKE MANY PARENTS, HER MOTHER CHOSE HERBAL SUPPLEMENTS INSTEAD OF PRESCRIPTION MEDICATION BECAUSE SHE WORRIED ABOUT POSSIBLE SIDE EFFECTS. THIS IS ONE OF THE MOST COMMONLY USED SUPPLEMENTS FOR A-D-H-D. ST. JOHN’S WORT.
VIDEO:
SOT/FULL
Super @:40
Wendy Weber, N.D., Ph.D., M.P.H.
Bastyr University
Runs: 06
AUDIO:
“I think the real concern with St. John’s Wort is that one we found that it didn’t work for A.D.H.D.”
VIDEO:
B-ROLL
Researcher at desk
GRAPHIC:
St. John’s Wort Study (title)
54 Children with A.D.H.D.
Ages 6 to 17
900mg/day St. John’s Wort
Others received placebo
AUDIO:
DR. WENDY WEBER IS A RESEARCHER AT BASTYR (baster) UNIVERSITY. SHE AND HER COLLEAGUES STUDIED FIFTY-FOUR CHILDREN WITH A-D-H-D AGES SIX TO SEVENTEEN. HALF RECEIVED NINE HUNDRED MILLIGRAMS OF ST. JOHN’S WORT A DAY FOR EIGHT WEEKS. THE OTHER HALF RECEIVED A PLACEBO.
VIDEO:
SOT/FULL
Wendy Weber, N.D., Ph.D., M.P.H.
Bastyr University
Runs: 08
AUDIO:
“We found that the individuals who took St. John’s Wort did no better than the children who took placebo. So we saw no beneficial effect of St. John’s Wort in our trial.”
VIDEO:
B-ROLL
GRAPHIC:
Restlessness
Hyperactivity
Lack of concentration
GFX/ JAMA COVER
AUDIO:
RESEARCHERS SAY SYMPTOMS INCLUDING RESTLESSNESS, HYPERACTIVITY, AND LACK OF CONCENTRATION PERSISTED. THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Wendy Weber, N.D., Ph.D., M.P.H.
Bastyr University
Runs: 11
AUDIO:
“Even though it’s a natural product does not necessarily mean that it’s safe and so you always want to talk to your healthcare provider about using those natural treatments and keep them informed because there can be interactions.”
VIDEO:
B-ROLL
Teen with ADHD reading
AUDIO:
ADRIANA ARJONA (R-hone-ah) STILL HAS TROUBLE CONCENTRATING AND SLEEPING.
VIDEO:
SOT/FULL
Adriana Arjona
Diagnosed with A.D.H.D.
Runs: 11
AUDIO:
“I hope that someday someone will be able to come out with a better, natural medicine for it and so that I can get to sleep.”
VIDEO:
B-ROLL
Teen doing school work
Pills pour into bottle
AUDIO:
A-D-H-D FOR HER HAS BECOME A WAY OF LIFE AND COPING WITH THE SYMPTOMS ARE PART OF THE ONGOING BATTLE TO FIND HELP. JENNIFER MITCHELL THE JAMA REPORT.
TAG:
This study looked at the use of St. John’s Wort by itself to treat A-D-H-D. Researchers recommend talking to your child’s doctor before trying any supplements and before combining them with other medication. For more information about this study you can log on to www.jama.com.
