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, September 2, 2008)
JAMA NEWS RELEASES
EXERCISE MAY HELP IMPROVE MEMORY PROBLEMS
MANY PARENTS OF CHRONICALLY ILL CHILDREN IN CALIFORNIA ARE UNAWARE OF PAID FAMILY LEAVE PROGRAM
COMPARISON OF APPROACHES TO PREVENT KIDNEY PROBLEMS RELATED TO ANGIOGRAPHY CONTRAST AGENTS FINDS LITTLE DIFFERENCE IN IMPROVEMENT OF OUTCOMES
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS PHYSICAL ACTIVITY MAY HELP IMPROVE COGNITIVE FUNCTION
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Embargoed for Release: 3:00 p.m. CT, Tuesday, September 2, 2008
Media Advisory: To contact Nicola T. Lautenschlager, M.D., email: nicolatl{at}unimelb.edu.au. To contact editorial author Eric B. Larson, M.D., call Joan DeClaire at 206-287-2653.
EXERCISE MAY HELP IMPROVE MEMORY PROBLEMS
CHICAGO—Adults with memory problems who participated in a home-based physical activity program experienced a modest improvement in cognitive function, compared to those who did not participate in the program, according to a study in the September 3 issue of JAMA.
As the world population ages, the number of older adults living with Alzheimer disease (AD) is estimated to increase from the current 26.6 million to 106.2 million by 2050. “If illness onset could be delayed by 12 months, 9.2 million fewer cases of AD would occur worldwide. For this reason, attempts have been made to identify individuals who are at increased risk of AD and to test interventions that might delay the progression of prodromal symptoms [early non-specific symptom, or set of symptoms] to full-blown dementia,” the authors write.
Nicola T. Lautenschlager, M.D., of the University of Melbourne, Australia, and colleagues conducted a randomized controlled trial to test whether a physical activity intervention would reduce the rate of cognitive decline among 138 adults age 50 years and older at increased risk of dementia. The participants, who reported memory problems but did not meet criteria for dementia, were randomly allocated to an education and usual care group or to a 24-week home-based program of physical activity.
The aim of the intervention was to encourage participants to perform at least 150 minutes of moderate-intensity physical activity per week, which participants were asked to complete in three 50-minute sessions each week. The most frequently recommended type of activity was walking. The intervention resulted in 142 minutes more physical activity per week or 20 minutes per day than with usual care. Cognitive function was assessed with the Alzheimer Disease Assessment Scale–Cognitive Subscale (ADAS-Cog; a measuring tool that consists of a number of cognitive tests) over 18 months.
The researchers found that by study end, participants in the exercise group had better ADAS-Cog scores and delayed recall than those in the usual care control group. Participants in the physical activity group also had lower Clinical Dementia Rating scores than those in the usual care group.
“To our knowledge, this trial is the first to demonstrate that exercise improves cognitive function in older adults with subjective and objective mild cognitive impairment. The benefits of physical activity were apparent after 6 months and persisted for at least another 12 months after the intervention had been discontinued. The average improvement of 0.69 points on the ADAS-Cog score compared with the usual care control group at 18 months is small but potentially important when one considers the relatively modest amount of physical activity undertaken by participants in the study,” the authors write.
“Unlike medication, which was found to have no significant effect on mild cognitive impairment at 36 months, physical activity has the advantage of health benefits that are not confined to cognitive function alone, as suggested by findings on depression, quality of life, falls, cardiovascular function, and disability.”
(JAMA. 2008;300[9]:1027-1037. 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: PHYSICAL ACTIVITY FOR OLDER ADULTS AT RISK FOR ALZHEIMER DISEASE
In an accompanying editorial, Eric B. Larson, M.D., of the Group Health Center for Health Studies, Seattle, comments on the findings regarding exercise and cognitive function.
“Health advances of the past century have led to more individuals surviving to extreme old age, when their risk of Alzheimer disease and related dementias increases substantially. Exercise—and possibly other lifestyle factors—appear to affect vascular risk and late-life brain health. In addition to traditional medical approaches to prevent this dreaded disease, social factors such as providing universal education, general medical care, a suitable environment, adequate nutrition, habitual exercise, and opportunities for continued social interactions throughout the lifespan also may contribute significantly to improve well-being in late life.”
(JAMA. 2008;300[9]:1077-1079. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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, September 2, 2008
Media Advisory: To contact Mark A. Schuster, M.D., Ph.D., call Rob Graham at 617-919-3110. To contact editorial author John M. Neff, M.D., call Teri Thomas at 206-987-5213.
MANY PARENTS OF CHRONICALLY ILL CHILDREN IN CALIFORNIA ARE UNAWARE OF PAID FAMILY LEAVE PROGRAM
CHICAGO—Parents of children with special health needs in California often are not aware that there is a paid family leave insurance program available for their use, with only 5 percent of those surveyed having used the program, according to a study in the September 3 issue of JAMA.
Chronically ill children, or children with special health care needs, comprise 13 percent to 17 percent of children in the United States, according to background information in the article. These illnesses include cerebral palsy, chronic kidney failure, congenital heart diseases, cystic fibrosis, degenerative neurological disorders and malignancies. “Children with special health care needs average 3 times as many medical encounters as other children, account for one-half of child hospital days, and miss nearly 3 times as much school. Their health-related needs create substantial pressure on parents to miss work,” the authors write.
In 2004, California’s Paid Family Leave Insurance Program (PFLI) became the first state program to provide paid leave to care for an ill family member, providing 6 weeks of non–job-protected paid leave annually for most part-time and full-time employees at approximately 55 percent of salary. It is a government-mandated insurance program that employees pay for through automatic payroll deductions. This program has been a model for state and federal paid family leave efforts, yet its impact is unknown.
Mark A. Schuster, M.D., Ph.D., of Children’s Hospital Boston and Harvard Medical School, and colleagues examined parents’ reports of taking leave before the start of PFLI (November 21, 2003 - January 31, 2004; n = 754) and after (November 18, 2005 - January 31, 2006; n = 766) its implementation. The researchers conducted telephone interviews with employed parents of children with special health care needs, randomly sampled from two children’s hospitals, one in California (with PFLI) and the other in Illinois (without PFLI).
The researchers found that only 77 parents (18 percent) reported having heard of PFLI and only 20 (5 percent) reported using it. California’s PFLI was not associated with an increase in the percentage of parents taking leave from before to after initiation of the program. Before PFLI began, 295 parents (81 percent) at the California site and 290 parents (78 percent) at the Illinois site took at least 1 day of leave in the previous year to care for their ill child compared with after PFLI began (327 parents [79 percent] at the California site and 296 parents [79 percent] at the Illinois site).
The Paid Family Leave Insurance Program also was not associated with an increase in the amount of leave parents took. Before PFLI began, 21 percent of parents at the California site and 14 percent of parents at the Illinois site took at least 4 weeks compared with after (19 percent of parents at the California site and 11 percent of parents at the Illinois site). Before PFLI began, 41 percent of parents at the California site and 36 percent of parents at the Illinois site said that at least once in the past year they did not miss work despite believing their child’s illness necessitated it. These figures were similar after PFLI began.
“Many factors may explain the minimal use of PFLI, but lack of awareness is likely important. Uptake of new policies generally requires a combination of awareness, low perceived costs (e.g., minimal income loss), and high perceived benefits (e.g., improving children’s health, allaying children’s fears),” the authors write.
“For policymakers considering paid leave programs, our findings suggest that it is insufficient for employees to learn about the program only when starting a new job or requesting leave. Additional dissemination (e.g., media campaigns, periodic employer-based notification of all employees) may raise awareness. Maximizing uptake of paid leave programs among parents of children with special health care needs may be a particularly important policy goal, given their substantial need for leave.”
(JAMA. 2008;300[9]:1047-1055. 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: PAID FAMILY LEAVE FOR PARENTS OF CHRONICALLY ILL CHILDREN
“To correct the deficiencies in the use of paid leave, extensive and frequent employee education about the existence of the program must occur,” writes John M. Neff, M.D., of Children’s Hospital and Regional Medical Center, Seattle, in an accompanying editorial in this week’s JAMA. “Ideally, future legislation should ensure that use of these funds will not affect future employment or job opportunities. Other important considerations include length of coverage, the amount of payment, and the funding source.”
“An important issue for states to consider is that failure to enact paid family leave legislation will likely increase costs to the state and to the family. Paid family leave legislation provides incentives to keep individuals in the work force, taking advantage of the upfront education and job training that has already occurred. Without such legislation, parents of children with serious chronic health conditions are likely to drop out of the work force and lose employment-based insurance. Medicaid case loads and expenses are likely to increase with increased enrollment of chronically ill children at the high end of the health care cost spectrum.”
(JAMA. 2008;300[9]:1080-1081. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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, September 2, 2008
Media Advisory: To contact Somjot S. Brar, M.D., call Alex Lyda at 212-305-0820.
COMPARISON OF APPROACHES TO PREVENT KIDNEY PROBLEMS RELATED TO ANGIOGRAPHY CONTRAST AGENTS FINDS LITTLE DIFFERENCE IN IMPROVEMENT OF OUTCOMES
CHICAGO—Use of sodium bicarbonate for hydration during coronary angiography for patients with kidney disease did not reduce the risk of developing serious kidney problems related to the use of contrast agents, compared to use of sodium chloride, according to a study in the September 3 issue of JAMA.
Nephropathy (disorder involving the kidneys or kidney function) is a known complication of exposure to iodine used as a contrast agent during angiography. Contrast-medium induced nephropathy is a common cause of kidney failure associated with prolonged hospitalization, increased health care costs and substantial illness and death. The reported incidence of contrast-induced nephropathy ranges from 2 percent in low-risk populations to 50 percent in high-risk populations. Animal models of kidney failure and one randomized clinical trial suggests that hydration with sodium bicarbonate may be an effective therapy for prevention of contrast-induced nephropathy, according to background information in the article.
Somjot S. Brar, M.D., of Columbia University Medical Center, New York, and colleagues conducted a study to evaluate the effect of sodium bicarbonate on the prevention of contrast medium–induced nephropathy. The randomized, controlled trial included 353 patients with moderate to severe kidney disease who were undergoing coronary angiography. Patients were randomized to receive either sodium chloride (n = 178) or sodium bicarbonate (n = 175), administered before, during and after coronary angiography. The median (midpoint) patient age was 71 years, and 45 percent of the patients had diabetes mellitus.
Overall, contrast-induced nephropathy assessed by estimated glomerular filtration rate (GFR; the flow rate of filtered fluid through the kidney) occurred in 13.9 percent (45/323) of the patients. The group receiving sodium chloride hydration had a 14.6 percent (24/165) incidence vs. 13.3 percent (21/158) in the sodium bicarbonate group. In patients randomized to receive sodium bicarbonate vs. sodium chloride, the rates of death, dialysis, heart attack, and cerebrovascular events did not differ significantly at 30 days or at 30 days to 6 months.
“The results of this study do not suggest that hydration with sodium bicarbonate is superior to hydration with sodium chloride in patients with moderate to severe chronic kidney disease who are undergoing coronary angiography. The overall incidence of contrast-induced nephropathy among patients was 13.9 percent and did not differ by treatment assignment. The frequency of clinical adverse events did not significantly differ between groups. Any true difference between the hydration strategies is likely to be small and not clinically significant,” the authors conclude.
(JAMA. 2008;300[9]:1038-1046. 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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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY FINDS PHYSICAL ACTIVITY MAY HELP IMPROVE COGNITIVE FUNCTION
INTRO:
With so many people living longer these days, it is estimated that the number of older adults living with Alzheimer’s disease worldwide will increase from about twenty-six million today to about one hundred and six million by the year 2050. Researchers are looking for ways to help delay the onset of dementia. A new study finds increasing physical activity may make a difference. Jennifer Mitchell explains in this week's JAMA Report.
VIDEO:
B-ROLL
Older people walking
Feet only
More walking
AUDIO:
WITH MILLIONS OF PEOPLE LIVING WITH ALZHEIMER’S DISEASE RESEARCHERS ARE LOOKING FOR INTERVENTIONS THAT MAY HELP DELAY DEVELOPMENT OF DEMENTIA.
VIDEO:
SOT/FULL
Super @ :10
Nicola Lautenschlager, M.D.
Old Age Psychiatrist
Runs: 10
AUDIO:
“There might be simple lifestyle factor which actually could help to delay the onset of dementia and its most common cause which is Alzheimer’s disease.”
VIDEO:
B-ROLL
Researcher walking
Researcher at desk
GRAPHIC:
Memory Study (title)
Group 1: 50 minutes exercise / 3 times wk
Group 2: Educational materials
AUDIO:
NICOLA LAUTENSCHLAGER (law-tin-schlager) IS A PSYCHIATRIST SPECIALIZING IN OLD AGE. SHE AND HER COLLEAGUES AT THE UNIVERSITY OF WESTERN AUSTRALIA LOOKED AT ABOUT ONE HUNDRED AND SEVENTY MEN AND WOMEN AGES FIFTY AND OLDER WHO REPORTED MEMORY TROUBLE BUT DID NOT HAVE DEMENTIA. PARTICIPANTS WERE RANDOMLY ASSIGNED INTO TWO GROUPS. GROUP ONE ENGAGED IN ABOUT 50 MINUTES OF MODERATE EXERCISE THREE TIMES A WEEK FOR SIX MONTHS. GROUP TWO RECEIVED EDUCATIONAL MATERIAL ABOUT MEMORY LOSS BUT WAS NOT ENCOURAGED TO EXERCISE.
VIDEO:
SOT/FULL
Nicola Lautenschlager, M.D.
Old Age Psychiatrist
Runs: 11
AUDIO:
“Physical activity made a difference. So those who did the program had a better memory and a better cognition at the end of the intervention after six months.”
VIDEO:
B-ROLL
GXF/JAMA COVER
File video: Elderly people eating
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
PARTICIPANTS WERE GIVEN COGNITIVE TESTS TO ASSESS THEIR MEMORY. THOSE WHO INCREASED THEIR PHYSICAL ACTIVITY SCORED HIGHER AND THEY HAD A BETTER MEMORY EVEN A YEAR AFTER THE INTERVENTION STOPPED.
VIDEO:
SOT/FULL
Nicola Lautenschlager, M.D.
Old Age Psychiatrist
Runs: 05
AUDIO:
“What we don’t know is at this point in time what the mechanism is underlying this effect.”
VIDEO:
B-ROLL
File video: people at table
People jogging and walking
AUDIO:
RESEARCHERS SAY WHILE THEY DON’T KNOW YET EXACTLY WHAT IS HAPPENING TO THE BRAIN THAT ALLOWS MEMORY TO IMPROVE, THE FINDINGS SUGGEST PHYSICAL ACTIVITY MAY ACTUALLY HELP TO PROTECT THE BRAIN AND COULD POTENTIALLY DELAY THE ONSET OF DEMENTIA.
JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Participants who were physically active and who scored higher on cognitive tests chose either walking or aerobic exercise and a few incorporated strength training activities into their routine. Doctor Lautenschlager is currently a Professor in Old Age Psychiatry at the University of Melbourne. For more information about this study you can log on to www.jama.com.
