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 p.m. CT Tuesday, December 23, 2008)
JAMA NEWS RELEASES
LONGER SLEEP DURATION ASSOCIATED WITH LOWER INCIDENCE OF CALCIFICATION IN CORONARY ARTERIES
AMONG OLDER ADULTS, PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS ARE COMMONLY USED TOGETHER
PSYCHIATRIC PATIENTS HAVE GREATER USAGE OF MENTAL HEALTH SERVICES WITH INSURANCE PLANS THAT PROVIDE EQUAL COST SHARING
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS 4% OF OLDER ADULTS WHO USE PRESCRIPTION AND NON-PRESCRIPTION MEDICATION ARE AT RISK OF MAJOR, HAZARDOUS DRUG INTERACTION
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
Please Note: This week's JAMA Report video is on the use of medications by older adults in the U.S. The report will be fed Tuesday, December 23, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
Please Note: Because JAMA does not publish on the 5th Wednesday of a month, there will be no JAMA or news releases for December 31.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 23, 2008
Media Advisory: To contact corresponding author Diane S. Lauderdale, Ph.D., call John Easton at 773-702-6241.
LONGER SLEEP DURATION ASSOCIATED WITH LOWER INCIDENCE OF CALCIFICATION IN CORONARY ARTERIES
CHICAGO—Participants in a study who slept on average an hour longer per night than other participants had an associated lower incidence of coronary artery calcification, which is thought to be a predictor of future heart disease, according to a study in the December 24/31 issue of JAMA.
Risk factors for coronary artery calcification (the accumulation of calcified plaques visible by computed tomography [a method of imaging body organs]) include established heart disease risk factors such as male sex, older age, glucose intolerance, tobacco use, dyslipidemia (disorders of lipoprotein metabolism, which includes high cholesterol levels), high blood pressure, obesity, raised inflammatory markers and attaining a low educational level. Recent data suggest that sleep quantity and quality are connected to several of these risk factors. "However, some of these correlations have only been documented in studies in which sleep is measured by self-report, which may be biased or insufficiently accurate," the authors write.
Christopher Ryan King, B.S., of the University of Chicago, and colleagues tested whether objectively measured sleep duration predicted the development of calcification over 5 years of follow-up. The study included 495 participants from the Coronary Artery Risk Development in Young Adults [CARDIA] study, who were black and white men and women age 35-47 years. At the start of the study in 2000-2001, the participants had no evidence of detectable coronary calcification on computed tomography scans.
Potential confounders (factors that can possibly influence the results; age, sex, race, education, apnea risk, smoking status) and mediators (lipids, blood pressure, body mass index, diabetes, inflammatory markers, alcohol consumption, depression, hostility, self-reported medical conditions) were measured at both the start of the study and at 5-year follow-up. Sleep metrics (wrist actigraphy [monitors rest and activity] measured sleep duration and sleep fragmentation, daytime sleepiness, overall sleep quality, self-reported sleep duration) were examined for association with new calcification, based on computed tomography performed in 2005-2006.
The incidence of calcification at 5 years was 12.3 percent (n = 61 participants). After adjusting for age, sex, race, education, smoking and apnea risk, the researchers found that one hour more of sleep per night decreased the estimated odds of calcification by 33 percent. The magnitude of the observed association was similar to sizable differences in established coronary risk factors (e.g., 1 additional hour of sleep reduced risk similarly to a reduction of 16.5 mm Hg in systolic blood pressure). No potential mediators appreciably altered the magnitude or significance of sleep. Alternative sleep metrics were not significantly associated with calcification.
"We have found a robust and novel association between objectively measured sleep duration and 5-year incidence of coronary artery calcification," the authors write. "This study further demonstrates the utility of a simple objective measure of sleep that can be used at home. Future studies will be needed for crucial extensions to these results. First, these results need confirmation in other cohorts. Second, does sleep moderate the rate at which calcification accumulates? Third, will objective sleep tie to coronary disease event outcomes over the long term? While calcification predicts such outcomes, it is difficult to know how and if the predictors of calcification themselves will determine outcomes, or if their impact will be purely mediated by their effect on calcification. Finally, if this association is born out, interventional studies will be needed to guide clinical advice."
(JAMA. 2008;300[24]:2859-2866. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 23, 2008
Media Advisory: To contact Dima M. Qato, Pharm.D., M.P.H., call John Easton at 773-702-6241.
AMONG OLDER ADULTS, PRESCRIPTION AND OVER-THE-COUNTER MEDICATIONS ARE COMMONLY USED TOGETHER
CHICAGO—A survey suggests that nearly half of older adults in the U.S. use prescription and over-the-counter medications together, and that about 4 percent of older adults are potentially at risk of an adverse drug reaction because of an interaction between medications, according to a study in the December 24/31 issue of JAMA. The researchers also found that nearly 30 percent use at least 5 prescription medications.
Rates of prescription medication use have increased considerably over the last several decades, as have the rates of use of over-the-counter medications and dietary supplements. Older adults are the largest per capita consumers of prescription medications and the most at risk for medication-related adverse events, according to background information in the article. "Despite concerns about drug safety and new federal policies to improve older adults' access to medications, current information on their concurrent [regular use of at least 2 medications] use of prescription medications, over-the-counter medications, and dietary supplements is limited," the authors write.
Dima M. Qato, Pharm.D., M.P.H., of the University of Chicago, and colleagues analyzed data from a survey to estimate the prevalence and patterns of medication use (including concurrent use) and major drug-drug interactions among older adults, age 57 through 85 years. The survey included 3,005 community-residing individuals, who were drawn from a cross-sectional, nationally representative sample of the United States. In-home interviews, including medication logs, were administered between June 2005 and March 2006. Medication use was defined as prescription, over-the-counter, and dietary supplements used "on a regular schedule, like every day or every week." The survey response rate was about 75 percent.
During 2005 to 2006, 91 percent of older adults, corresponding to 50.5 million adults age 57 to 85 years, regularly used at least 1 medication. Among all medication types, prescription medication use was the most prevalent, used by 81 percent, or an estimated 44.9 million older adults. The prevalence of prescription medication use was highest among the oldest age group, age 75 to 85 years. Nearly one-half of older adults regularly used at least 1 over-the-counter medication or dietary supplement. Women were more likely to use prescription medications and dietary supplements than men, whereas use of over-the counter medications was similar among women and men.
More than half of older adults used 5 or more prescription medications, over-the-counter medications or dietary supplements. For prescription medications, 29 percent of all respondents used more than 5 medications. The prevalence of the use of 5 or more prescription medications increased steadily with age for both men and women and was overall significantly higher among women.
Overall, 68 percent of older adults using prescription medications were concurrently using over-the-counter medications, dietary supplements, or both. The researchers also found that 1 in 25 (4 percent) older adults (approximately 2.2 million) were at risk for a major potential drug-drug interaction. The rate of any major medication interaction increased with age for both men and women but was higher among men compared with women across all age groups. More than half of these major interactions involved the use of nonprescription therapies. In addition, nearly half involved the use of anticoagulants (e.g., warfarin) or antiplatelet agents (e.g., aspirin).
"Several factors have likely contributed to this increase in the rate of [the use of five or more medications] among older adults over the last decade. These include intensification of therapy for common chronic medical conditions (e.g., diabetes, cardiovascular disease), increased access to medications because of policy changes (e.g., Medicare Part D and assistance programs), and growth of the generic drug market," the authors write.
"One recent report estimated that U.S. adults older than 65 years make more than 175,000 emergency department visits annually for adverse drug events; commonly prescribed medications accounted for one-third of these events," the researchers note. "Our findings suggest that concurrent use of prescription and nonprescription medications in older adults remains a public health problem and could be an important focal point for further improvements in drug safety for seniors."
"Medications are a critical modality for prolongation of life and improved quality of life for many older adults. By establishing patterns of prescription and nonprescription medication use among older adults, these data may help support efforts to increase the safety and quality of pharmacotherapy for older adults," the authors conclude.
(JAMA. 2008;300[24]:2867-2878. 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.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, December 23, 2008
Media Advisory: To contact Amal N. Trivedi, M.D., M.P.H., call Mark Hollmer at 401-863-1862.
PSYCHIATRIC PATIENTS HAVE GREATER USAGE OF MENTAL HEALTH SERVICES WITH INSURANCE PLANS THAT PROVIDE EQUAL COST SHARING
CHICAGO—Following a psychiatric discharge, Medicare patients in insurance plans that provide equal cost sharing for mental health services have higher use of those services compared to patients in plans that require greater cost sharing, according to a study in the December 24/31 issue of JAMA.
Health insurers in the United States have historically treated mental illness as distinct from all other medical illnesses by imposing higher out-of-pocket costs and instituting special restrictions for the use of mental health services. "Advocates for parity [equal cost sharing] argue that restricted mental health coverage unfairly discriminates against individuals with mental illness. ...Because less than half of individuals with mental illness receive care for their condition, parity in insurance coverage could improve the use of effective treatment," the authors write. "Timely outpatient mental health care following a psychiatric hospitalization is associated with fewer readmissions, more effective transitions to community-based services, and improved mental health outcomes."
In 2008, the U.S. Congress enacted legislation requiring parity in insurance coverage for mental health services in group health plans covering more than 50 employees and Medicare Part B beginning in 2010. Few studies have assessed the effect of parity on the access and quality of mental health care, according to background information in the article.
Amal N. Trivedi, M.D., M.P.H., of the Warren Alpert Medical School at Brown University, Providence, R.I., and colleagues examined the relation between parity in outpatient cost sharing and whether enrollees had an outpatient mental health visit within 7 and 30 days following a hospitalization for mental illness. The researchers reviewed cost-sharing requirements for outpatient mental and general medical services for 302 Medicare health plans from 2001 to 2006. Among 43,892 enrollees in 173 health plans who were hospitalized for a mental illness, the relation of parity in cost sharing and receipt of timely outpatient mental health care after discharge was determined using cross-sectional analyses of all Medicare plans and longitudinal analyses of 10 plans that discontinued parity compared with 10 matched control plans that maintained parity.
More than three-quarters of Medicare plans, representing 79 percent of Medicare enrollees, required greater cost sharing for mental health care compared with primary or specialty care. The researchers found that individuals in full-parity plans were more likely to visit a mental health practitioner within 7 and 30 days after a hospitalization compared with enrollees in Medicare plans with intermediate or no parity. For example, co-payments that were $14 greater in plans without parity compared with full-parity plans were associated with an 11 percentage point lower rate of follow-up after a psychiatric hospitalization.
The researchers also examined the association between insurance parity and follow-up visits for individuals from areas of lower income and education. Individuals in the lowest quarter of area-level income had a 7-day follow-up rate that was 14.7 percentage points lower in plans with no parity vs. plans with full parity, and for individuals in the lowest quarter of area-level education, the 30-day follow-up rate was 18.3 percentage points lower in plans with no parity vs. plans with full parity.
Rates of follow-up visits within 30 days decreased by 7.7 percentage points in plans that discontinued parity and increased by 7.5 percentage points among control plans that maintained parity.
"Most Medicare health plans, like most commercial health plans, have unequal coverage for mental health services compared with other medical services. Enrollees in plans without parity in cost sharing are less likely to receive timely outpatient care following a hospitalization for mental illness. While prior studies have shown that adoption of mental health parity does not increase mental health spending, parity legislation that equalizes cost sharing for mental health and primary care may increase the use of clinically appropriate mental health services," the authors conclude.
(JAMA. 2008;300[24]:2879-2885. 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.
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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
STUDY FINDS 4% OF OLDER ADULTS WHO USE PRESCRIPTION AND NON-PRESCRIPTION MEDICATION ARE AT RISK OF MAJOR, HAZARDOUS DRUG INTERACTION
INTRO:
Older adults are the most likely to use prescription medication. But many are also taking non-prescription drugs – like aspirin and vitamin supplements – at the same time. And that can put them at risk for hazardous drug interaction. Alissa Krinsky explains in this week's JAMA Report.
VIDEO:
B-ROLL
Medications on Shelves
Calcium Bottles
Ingredient Table
AUDIO:
THEY'RE COMMON PRESCRIPTION AND NON-PRESCRIPTION MEDICATIONS. BUT WHEN TAKEN IN COMBINATION, THEY CAN CAUSE PROBLEMS FOR THE MOST VULNERABLE AMONG US: OLDER ADULTS.
VIDEO:
SOT/FULL
Super @ :12
Stacy Tessler Lindau, M.D., M.A.P.P.
The University of Chicago Medical Center
Runs :14
AUDIO:
"The number of medications older adults are taking are increasing and we worry about the potential interactions between these drugs because they may have some safety implications for older adults."
VIDEO:
B-ROLL
Shelves of Medication in Pharmacy
AUDIO:
COMBINING DRUGS CAN RESULT IN INTERNAL BLEEDING, AMONG OTHER SERIOUS PROBLEMS.
VIDEO:
SOT/FULL
Stacy Tessler Lindau, M.D., M.A.P.P.
The University of Chicago Medical Center
Runs :05
AUDIO:
"Combinations of medications may reduce the effectiveness of one or the other medication."
VIDEO:
B-ROLL
Researchers walking
AUDIO:
DOCTOR STACY TESSLER LINDAU (Lin'-dow) AND LEAD RESEARCHER DIMA (Deem'-uh) QATO (Kay'-toe) OF THE UNIVERSITY OF CHICAGO MEDICAL CENTER – AND THEIR COLLEAGUES - DECIDED TO LOOK AT MEDICATION USE AMONG OLDER ADULTS.
VIDEO:
SOT/FULL
Super @ :44
Dima M. Qato, Pharm.D., M.P.H.
The University of Chicago Medical Center
Runs :10
AUDIO:
"No one has ever really documented how many medications, what types of medications, older people use, on such a large scale including non-prescription drugs, along with prescription drugs."
VIDEO:
B-ROLL
GXF/JAMA COVER
GFX/
Study: Medication Use Among Older Adults
- Over 3,000 People
- Ages 57-85
About Use of Medications:
- Prescriptions (e.g., Blood Thinners)
- Over-the-Counter Drugs (e.g., Aspirin)
- Vitamins and Herbal Supplements (e.g., Ginkgo Biloba)
GFX/
Study Finding
Nearly 1 in 25 People (4%) At Risk For Major, Hazardous Drug Interaction
AUDIO:
THE STUDY APPEARS THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION. IT ANALYZED DATA COLLECTED FROM OVER THREE THOUSAND PEOPLE...AGES 57-85... ABOUT THEIR USE OF PRESCRIPTION DRUGS LIKE BLOOD-THINNERS... OVER-THE-COUNTER DRUGS, SUCH AS ASPIRIN... AND VITAMINS AND HERBAL SUPPLEMENTS, LIKE GINKGO BILOBA. THE STUDY FOUND THAT NEARLY ONE IN TWENTY-FIVE PEOPLE – FOUR PERCENT – WERE AT RISK FOR MAJOR, HAZARDOUS DRUG INTERACTION.
VIDEO:
SOT/FULL
Stacy Tessler Lindau, M.D., M.A.P.P.
The University of Chicago Medical Center
Runs :12
AUDIO:
"One of the important findings is that, specifically for older men, ages 75-85, one in 10 were using combinations of drugs that put them at risk for a severe medication interaction."
VIDEO:
B-ROLL
Researchers sitting at table
AUDIO:
RESEARCHERS RECOMMEND THAT DOCTORS AND PHARMACISTS BE CAREFUL WHEN PRESCRIBING AND DISPENSING DRUGS...AND THAT PATIENTS TAKE PRECAUTIONS, TOO.
VIDEO:
SOT/FULL
Dima M. Qato, Pharm.D., M.P.H.
The University of Chicago Medical Center
Runs :06
AUDIO:
"They have to make sure they discuss all their medications with their physician and their pharmacist."
VIDEO:
SOT/FULL
Stacy Tessler Lindau, M.D., M.A.P.P.
The University of Chicago Medical Center
Runs :08
AUDIO:
"Not only the prescription medications, but also the medications they buy over-the-counter."
VIDEO:
B-ROLL
Pharmacist's hands with bottles and pills
AUDIO:
BECAUSE WHEN IT COMES TO MEDICATION USE, BEING CAREFUL CAN BE CRITICAL. ALISSA KRINSKY, THE JAMA REPORT.
TAG:
The study showed that eighty-one percent of study participants used at least one prescription medication and that sixty-eight percent of those who took prescription drugs also used over-the-counter medication, dietary supplements, or both. For more information about this study you can log on to www.jama.com.
