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, February 9, 2009)
Multivitamin Use Not Associated With Women's Risk of Cancer, Heart Disease or Death
New Diagnoses May Provide Window of Opportunity for Health Behavior Change
Ongoing Statin Therapy Associated With Lower Risk of Death
Study Examines Effects of Exercise on Quality of Life in Postmenopausal Women
Physicians May Face Challenging Workplace Conditions in Clinics Serving Minority Patients
ARCHIVES OF NEUROLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), February 9, 2009)
Mediterranean Diet Associated With Lower Risk of Cognitive Impairment
ARCHIVES OF OPHTHALMOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), February 9, 2009)
Immunosuppressant Medication May Be Cost-Effective for Dry Eye Syndrome
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 9, 2009
Media Advisory: To contact Marian L. Neuhouser, Ph.D., call Kristen Lidke Woodward at 206-667-5095 or e-mail kwoodwar{at}fhcrc.org.
Multivitamin Use Not Associated With Women's Risk of Cancer, Heart Disease or Death
CHICAGO—Postmenopausal women who take multivitamins appear to have the same risk of most common cancers, cardiovascular disease or dying of any cause as women who do not take multivitamin supplements, according to a report in the February 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
About half of Americans use dietary supplements, spending more than $20 billion per year on these products, according to background information in the article. "The motivations for supplement use vary, but common reasons include the belief that these preparations will prevent chronic diseases, such as cancer and cardiovascular disease," the authors write. "These views are often fueled by product health claims, consumer testimonials and an industry that is largely unregulated owing to the 1994 Dietary Supplement and Health Education Act." Scientific data supporting the benefits of supplements—including multivitamins, the most commonly used supplements—are lacking.
Marian L. Neuhouser, Ph.D., of the Fred Hutchinson Cancer Research Center, Seattle, and colleagues analyzed data from participants in the Women's Health Initiative (WHI): 161,808 women from three clinical trials testing hormone therapy, dietary modification and vitamin D supplements and 93,676 women who were part of an observational study. The women enrolled in the WHI between 1993 and 1998; information about vitamin use was collected through interviews and by supplement bottles brought to clinic visits.
A total of 41.5 percent of the participants used multivitamins. Through 2005 (a median or midpoint of eight years of follow-up for the clinical trials and 7.9 years for the observational study), 9,619 cases of breast, colorectal, endometrial, renal, bladder, stomach, lung or ovarian cancer developed; 8,751 cardiovascular events, such as heart attack and stroke, occurred; and 9,865 deaths were reported. Analyses revealed no significant associations between multivitamin use and the likelihood of developing cancer or cardiovascular disease, or of dying.
"Risk estimates did not materially change when stratified by class of multivitamins, with the exception of a possible lower risk of myocardial infarction [heart attack] among users of stress-type supplements. Many stress supplements include high doses of folic acid and other B vitamins; previous studies have supported a protective role for folic acid in relation to cardiovascular disease and its antecedent risk factors," the authors write.
"These results suggest that multivitamin use does not confer meaningful benefit or harm in relation to cancer or cardiovascular disease risk in postmenopausal women," the authors conclude. "Nutritional efforts should remain a principal focus of chronic disease prevention, but without definitive results from a randomized controlled trial, multivitamin supplements will not likely play a major role in such prevention efforts."
(Arch Intern Med. 2009;169[3]:294-304. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The WHI program is funded by the National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services. 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, February 9, 2009
Media Advisory: To contact Patricia S. Keenan, Ph.D., M.S., call Helen Dodson at 203-436-3984 or e-mail helen.dodson@yale.edu. To contact editorial author Sherry Pagoto, Ph.D., call Alison Duffy or Jim Fessenden at 508-856-2000 or e-mail alison.duffy{at}umassmed.edu or james.fessenden{at}umassmed.edu.
New Diagnoses May Provide Window of Opportunity for Health Behavior Change
CHICAGO—Older adults appear more likely to quit smoking or lose weight following a recent diagnosis of heart disease, diabetes or another serious condition, according to a report in the February 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"Smoking and patterns of diet and activity are the two leading underlying causes of death in the United States, yet the factors that prompt individuals to adopt healthier habits are not well understood," the author writes as background information in the article. One-fifth of U.S. adults older than 25 smoke, and two-thirds of adults age 20 to 75 years are overweight or obese. Clinical guidelines recommend weight loss and smoking cessation to prevent health risks in these individuals, and advise physicians to counsel their patients about these options.
Patricia S. Keenan, Ph.D., M.H.S., of Yale School of Medicine and Yale School of Public Health, New Haven, Conn., analyzed data from the Health and Retirement Study, a survey of middle-aged and older adults. Participants were first surveyed in 1992 and subsequent surveys have been conducted every other year. A total of 20,221 overweight or obese individuals younger than 75 years and 7,764 smokers were surveyed at least twice between 1992 and 2000.
Over the course of the surveys, 18 percent of smokers quit and average body mass index increased by 0.04 units in the overweight and obese group. About 13 percent of smokers were diagnosed with stroke, cancer, lung disease, heart disease or diabetes, while 8 percent of overweight or obese individuals received a diagnosis of lung disease, heart disease or diabetes.
"Individuals with new diagnoses were more likely to adopt healthier habits than those without recent new diagnoses," Dr. Keenan writes. Smokers had 3.2 times the odds of quitting if they had received at least one of the five diagnoses vs. no new diagnoses. The overweight or obese individuals who were diagnosed with lung disease, heart disease or diabetes lost an average of 2 to 3 pounds more than those who were not diagnosed with any of these conditions.
Multiple diagnoses were associated with a greater magnitude of behavior change—compared with smokers who received no new diagnoses, those with one diagnosis had 2.9 times greater odds of quitting and those with multiple new diagnoses had 6.1 times greater odds of quitting. Overweight or obese individuals with one new diagnosis decreased their body mass index (BMI) by an average of 0.34 units, while those with more than one diagnosis lost an average of 0.64 units.
"Changes were particularly pronounced in smokers with stroke, cancer or heart disease and in overweight individuals with diabetes mellitus," Dr. Keenan writes.
"Targeting individuals with recent new diagnoses may be particularly effective in middle-aged and older individuals, who are increasingly likely to receive a major diagnosis or to be hospitalized as they age," she continues. "Individuals with new adverse health events are accessible through contact with the health care system or through the Internet or other written information about their disease, and this study suggests that they are more motivated to change health habits."
(Arch Intern Med. 2009;169[3]:237-242. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by grants from the National Institute on Aging, National Institutes of Health. Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Window of Opportunity May Be Lost Due to Inadequate Access
"Identifying windows of opportunity for patient receptiveness to lifestyle changes could help guide physicians as to when counseling will have the greatest effect," write Sherry Pagoto, Ph.D., and Judith Ockene, Ph.D., of the University of Massachusetts Medical School, Worcester, in an accompanying editorial.
"However, the effect of physician advice might only be as good as the availability of supportive services to which patients can be referred for specialized preventive care. Our health care system is incomplete to the extent that patients and healthy subjects do not have affordable access to evidence-based preventive services," they conclude.
(Arch Intern Med. 2009;169[3]:217-218. 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, February 9, 2009
Media Advisory: To contact corresponding author Gabriel Chodick, Ph.D., e-mail hodick_g{at}mac.org.il.
Ongoing Statin Therapy Associated With Lower Risk of Death
CHICAGO—Patients with high cholesterol levels who continually take statins appear to have a lower risk of death over four to five years, regardless of whether they already have diagnosed heart disease, according to a report in the February 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Statin drugs have been shown to have a beneficial effect on levels of low-density lipoprotein (LDL, or "bad") cholesterol, according to background information in the article. The benefits of these medications have been demonstrated in clinical trials for secondary prevention (controlling risk factors and preventing death in patients who already have heart disease). However, some have questioned the effectiveness of statins for preventing deaths in patients taking them for primary prevention (delaying or preventing the development of heart disease).
Varda Shalev, M.D., and colleagues at Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv, Israel, analyzed data from 229,918 adults (average age 57.6) enrolled in a health maintenance organization who began taking statins between 1998 and 2006. This included 136,052 individuals without heart disease (primary prevention group), who were followed for an average of four years, and 93,866 already diagnosed with heart disease (secondary prevention group), with an average five years of follow-up. Researchers checked pharmacy records to calculate the proportion of days that each individual took statins.
During the study, 4,259 patients in the primary prevention group and 8,906 in the secondary prevention group died. In both groups, continuity of taking statins—defined as taking statins for at least 90 percent of the follow-up period—conferred at least a 45 percent reduction in the risk of death compared with patients who took statins less than 10 percent of the time. The risk reduction was stronger among patients with high levels of LDL cholesterol at the beginning of the study and among patients whose initial treatment was with high-efficacy statins.
"In conclusion, this study showed that the continuation of statin treatment provided an ongoing reduction in all-cause mortality [death] for up to 9.5 years among patients with and without a history of coronary heart disease," they continue. "The observed benefits from statins were greater than expected from randomized clinical trials, emphasizing the importance of promoting statin therapy and increasing its continuation over time for both primary and secondary prevention."
(Arch Intern Med. 2009;169[3]:260-268. 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, February 9, 2009
Media Advisory: To contact Corby K. Martin, Ph.D., call Glen Duncan at 225-763-2599 or e-mail Glen.Duncan{at}pbrc.edu.
Study Examines Effects of Exercise on Quality of Life in Postmenopausal Women
CHICAGO—Exercise appears to improve quality of life in postmenopausal women regardless of whether they lose weight, according to a report in the February 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
Physical inactivity is a risk factor for various chronic conditions including diabetes mellitus, heart disease, stroke and several types of cancers, according to background information in the article. Regular physical activity is often reported to improve mood, reduce stress and increase energy levels, all of which are measurements of quality of life. However, these claims are largely derived from studies composed of participants with serious illnesses and have not been confirmed in healthy populations.
Corby K. Martin, Ph.D., of the Pennington Biomedical Research Center and Louisiana State University System, Baton Rouge and colleagues studied the effect of 50 percent, 100 percent and 150 percent of current public health physical activity recommendations on quality of life in 430 sedentary postmenopausal women (average age 57.4). Participants were randomly assigned to a non-exercise control group (n=92) or one of three exercise groups: exercise energy expenditure of 4 kilocalories per kilogram (2.2 pounds) of body weight per week (4-KKW) (n=147), 8-KKW (n=96) or 12-KKW (n=95). A short health survey was used to measure physical and mental aspects of quality of life at the beginning of the study and six months later.
"Adherence to exercise was 95.4 percent, 88.1 percent and 93.7 percent for the 4-, 8- and 12-KKW groups, respectively, and each group spent 73.9, 138.3 and 183.6 minutes per week exercising," the authors write. The average weight loss in the control, 4-KKW, 8-KKW and 12-KKW groups was 0.94 kilograms (2.07 pounds), 1.34 kilograms (2.95 pounds), 1.86 kilograms (4.10 pounds) and 1.34 kilograms (2.95 pounds), respectively.
"A dose-response effect of exercise on quality of life was noted for all aspects of quality of life except bodily pain," they note. "In addition, the 4-KKW group had significantly improved general health perception, vitality and mental health compared with the control group. All three exercise groups had significantly improved social functioning compared with the control group."
"Our results indicate that improved quality of life can be added to the list of exercise benefits and that these improvements are dose dependent and independent of weight loss, at least among people similar to this study's sample," the authors conclude. "The exercise doses are easily obtainable and were well tolerated by sedentary women, resulting in confidence that the exercise doses used in this study can be achieved by women in the community."
(Arch Intern Med. 2009;169[3]:269-278. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institutes of Health. Life Fitness (Schiller Park, Illinois) provided exercise equipment. 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, February 9, 2009
Media Advisory: To contact Anita B. Varkey, M.D., call Nora Plunkett at 708-216-6268 or e-mail nplunkett{at}lumc.edu.
Physicians May Face Challenging Workplace Conditions in Clinics Serving Minority Patients
CHICAGO—Primary care clinics with a higher proportion of minority patients appear to have more adverse physician workplace conditions and challenging organizational characteristics, according to a report in the February 9 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.
"Minority Americans have poorer health outcomes from chronic conditions such as cancer, asthma, heart disease and diabetes mellitus," the authors write as background information in the article. "Some of these poorer outcomes are attributable to disparities in health care resulting from a myriad of access, patient and physician factors."
Anita B. Varkey, M.D., of Loyola University Medical Center, Maywood, Ill., and colleagues analyzed data collected from surveys of 96 clinic managers, 388 primary care physicians and 1,701 adult patients with chronic diseases completed between 2001 and 2005. They compared data from 27 of the 96 clinics whose patient base was composed of at least 30 percent minority patients to those from the other 69 clinics. The 27 clinics serving a high proportion of minorities accounted for 162 of 388 physicians (41.8 percent) and 780 of 1,701 patients (45.9 percent) who participated.
"Physicians from 27 clinics with at least 30 percent minority patients reported less access to medical supplies and to referral specialists than physicians from the other clinics," the authors write. "These 27 clinics had poorer access to pharmacy services, fewer patient examination rooms per physician and limited written educational materials for patients with hypertension and congestive heart failure."
Physicians at these clinics were four times more likely to report having a chaotic work environment and half as likely to report having high job satisfaction. In addition, these physicians were more likely to report that their patients speak little to no English (27.1 percent vs. 3.4 percent), have chronic pain (24.1 percent vs. 12.9 percent), and are medically (53.1 percent vs. 39.9 percent) and psychosocially (44.9 percent vs. 28.2 percent) complex. The patients were more frequently depressed (22.8 percent vs. 12.1 percent), are more often covered by Medicaid (30.2 percent vs. 11.4 percent) and report lower health literacy (3.7 vs. 4.4, on a scale where one is lowest and five is highest).
"This study provides evidence of resource and workplace organizational disparities between clinics that serve large numbers of minority patients and clinics that do not," the authors write. "These deficiencies may contribute to physician stress and time pressure, thereby complicating interactions with disproportionately higher percentages of medically and psychosocially complex patients. The combination of time pressure, insufficient resources and complex patients likely constitutes a 'perfect storm' that contributes to the challenges that physicians face in providing quality care to large proportions of minority patients."
"National strategies to examine and intervene in health care disparities should consider the work environment as a potential determinant of disparities and as a target for interventions to reduce physician burnout, increase work control and reduce clinic chaos," they conclude. These interventions may include better reimbursement for primary care and more widely available health insurance.
(Arch Intern Med. 2009;169[3]:243-250. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: The design and conduct of the study were supported by a grant from the Agency for Healthcare Research and Quality. Interpretation of the data and preparation of the manuscript were funded by a grant from the Robert Wood Johnson Foundation. Co-author Dr. Ibrahim is a Robert Wood Johnson Foundation Harold Amos Faculty Development Scholar. 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 Nikolaos Scarmeas, M.D., call Elizabeth Streich at 212-305-6535 or e-mail eas2125{at}columbia.edu.
Mediterranean Diet Associated With Lower Risk of Cognitive Impairment
CHICAGO—Eating a Mediterranean diet appears to be associated with less risk of mild cognitive impairment—a stage between normal aging and dementia—or of transitioning from mild cognitive impairment into Alzheimer's disease, according to a report in the February issue of Archives of Neurology, one of the JAMA/Archives journals.
"Among behavioral traits, diet may play an important role in the cause and prevention of Alzheimer's disease," the authors write as background information in the article. Previous studies have shown a lower risk for Alzheimer's disease among those who eat a Mediterranean diet, characterized by high intakes of fish, vegetables, legumes, fruits, cereals and unsaturated fatty acids, low intakes of dairy products, meat and saturated fats and moderate alcohol consumption.
Nikolaos Scarmeas, M.D., and colleagues at Columbia University Medical Center, New York, calculated a score for adherence to the Mediterranean diet among 1,393 individuals with no cognitive problems and 482 patients with mild cognitive impairment. Participants were originally examined, interviewed, screened for cognitive impairments and asked to complete a food frequency questionnaire between 1992 and 1999.
Over an average of 4.5 years of follow-up, 275 of the 1,393 who did not have mild cognitive impairment developed the condition. Compared with the one-third who had the lowest scores for Mediterranean diet adherence, the one-third with the highest scores for Mediterranean diet adherence had a 28 percent lower risk of developing mild cognitive impairment and the one-third in the middle group for Mediterranean diet adherence had a 17 percent lower risk.
Among the 482 with mild cognitive impairment at the beginning of the study, 106 developed Alzheimer's disease over an average 4.3 years of follow-up. Adhering to the Mediterranean diet also was associated with a lower risk for this transition. The one-third of participants with the highest scores for Mediterranean diet adherence had 48 percent less risk and those in the middle one-third of Mediterranean diet adherence had 45 percent less risk than the one-third with the lowest scores.
The Mediterranean diet may improve cholesterol levels, blood sugar levels and blood vessel health overall, or reduce inflammation, all of which have been associated with mild cognitive impairment. Individual food components of the diet also may have an influence on cognitive risk. "For example, potentially beneficial effects for mild cognitive impairment or mild cognitive impairment conversion to Alzheimer's disease have been reported for alcohol, fish, polyunsaturated fatty acids (also for age-related cognitive decline) and lower levels of saturated fatty acids," they write.
Additional studies are needed to confirm the role of this or other dietary factors in the development of cognitive impairment and Alzheimer's disease, they conclude.
(Arch Neurol. 2009;66[2]:216-225. 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. 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, February 9, 2009
Media Advisory: To contact Melissa M. Brown, M.D., M.N., M.B.A., call 215-353-6249 or e-mail mbrown{at}valuebasedmedicine.com.
Immunosuppressant Medication May Be Cost-Effective for Dry Eye Syndrome
CHICAGO—A topical eye emulsion consisting of cyclosporine (a medication used to reduce transplant rejections or to treat arthritis and psoriasis) may be a cost-effective treatment for dry eye syndrome that does not respond to other therapies, according to a report in the February issue of Archives of Ophthalmology, one of the JAMA/Archives journals.
Published reports suggest that the prevalence of dry eye syndrome in older patients ranges from about 15 percent to 34 percent, according to background information in the article. "Patients with dry eye syndrome have more difficulty reading, carrying out professional work, using a computer, watching television and driving compared with those without dry eyes," the authors write. "The burden of dry eye disease from both the prevalence and patient morbidity standpoints makes this a sizeable public health dilemma."
Using data from two randomized clinical trials and Food and Drug Administration files, Melissa M. Brown, M.D., M.N., M.B.A., of the Center for Value-Based Medicine, Flourtown, and the University of Pennsylvania School of Medicine, Philadelphia, and colleagues assessed the comparative effectiveness and cost-effectiveness of eye drops containing a 0.05 percent emulsion of the drug cyclosporine for patients whose moderate to severe dry eye syndrome did not respond to conventional therapy.
When compared with eye drops containing only lubricant, the cyclosporine drops were associated with a 4.3 percent improvement in quality of life, and conferred a 7.1 percent improvement over no treatment. The total direct medical cost associated with the use of this drug was $1,834; however, because 24.5 percent of treated workers will return to full productivity as a result, there is an estimated $1,236 gain associated with treatment, reducing the net cost to $598.
Based on the authors' analysis, the cost to society for treatment with this medication was $34,953 more per quality-adjusted life year (a measure combining the quality and quantity of life) than the lubricant eye drops alone. This is well below the conventional standard of $50,000 per quality-adjusted life year that most would consider cost-effective, they note.
"The use of topical cyclosporine is a cost-effective treatment strategy for a common disease that, when unresponsive to conventional lubricant therapy, causes a marked diminution in quality of life," the authors conclude.
(Arch Ophthalmol. 2009;127[2]:146-152. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by Allergan Inc.; the Center for Value-Based Medicine, Flourtown, Pa.; and the Eye Research Institute, Philadelphia. 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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