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May 25, 2009JAMA 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, May 25, 2009)
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED. JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access. Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 25, 2009
Inner Ear Balance Disorders Common, Associated With Falls Among Older Americans
CHICAGO—An estimated 35 percent of U.S. adults age 40 and older have vestibular dysfunction (inner ear balance disorders), and those who do may have a higher risk of falling, according to a report in the May 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The vestibular system helps control an individual’s balance, according to background information in the article. The two vestibular organs, within the temporal bone at the side and base of the skull, provide input to the brain about head motion and orientation relative to gravity. "Vestibular dysfunction is typically characterized by vertigo (i.e., an illusory sense of motion) and imbalance owing to disturbances in gaze and postural stability," the authors write. "In some cases, vestibular dysfunction can culminate catastrophically in a fall, which is associated with serious injury and restricted mobility and ranks among the leading causes of death among older individuals." Despite these concerns, little has previously been known about the prevalence of vestibular dysfunction in the United States, in part because of the difficulty of diagnosis. Yuri Agrawal, M.D., and colleagues at The Johns Hopkins University School of Medicine, Baltimore, analyzed data from a nationally representative sample of 5,086 adults who participated in the 2001-2004 National Health and Nutrition Examination Surveys. Participants completed a balance questionnaire, which determined history of dizziness and falls, and underwent in-person balance testing that involved standing on different surfaces under varying conditions (for instance, with their eyes closed). As determined by these tests, the overall prevalence of vestibular dysfunction in the U.S. population aged 40 and older from 2001 through 2004 was 35.4 percent. "Odds of vestibular dysfunction increased significantly with age, were 40.3 percent lower in individuals with more than a high school education and were 70 percent higher among people with diabetes mellitus," the authors write. Individuals with vestibular dysfunction were more likely to report having dizziness and a history of falls. The 26.8 percent of participants who had symptoms of vestibular dysfunction, including dizziness, had an eight-fold increase in the odds of falling. Individuals who were asymptomatic also had significantly increased odds of falling. In addition, participants with vestibular dysfunction had an increased risk of hearing loss, which likely reflects the similar anatomic locations of the vestibular and hearing organs as well as their common blood supply.
"These findings suggest the importance of diagnosing and treating vestibular deficits to reduce the burden of fall-related injuries and deaths," the authors write. "Given the high prevalence of this impairment, notably among the elderly, and the extraordinary costs associated with falls (exceeding $20 billion annually), screening for vestibular dysfunction in assisted living or nursing home facilities, for example, could be a life-saving and cost-effective practice. Screening may be particularly effective in groups at heightened risk of vestibular dysfunction, specifically non-whites, individuals with less than a high school education, people with diabetes and the hearing impaired."
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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 25, 2009
Retail Clinics Less Likely to Be Located in Underserved Communities
CHICAGO—Despite reports indicating that placement of retail clinics are determined by physician shortages and higher uninsured populations, these clinics appear to be located in more advantaged neighborhoods, according to a report in the May 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. "Retail clinics are medical clinics located within larger retail outlets that are usually staffed by nurse practitioners and supervised by an off-site physician," according to background information in the article. Retail clinics usually focus on urgent care and routine preventive services, such as immunizations. These facilities tend to be open on nights and weekends, usually provide service without appointments and tend to have lower prices than those charged by primary care physicians or emergency departments. Craig Evan Pollack, M.D., M.H.S. and Katrina Armstrong, M.D., M.S.C.E., of the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, mapped locations of retail clinics as of July 2008 and linked them to the 2000 U.S. Census and 2008 Health Resources and Services Administration data to determine if the clinics are typically located in areas with higher medical need. "A total of 930 retail clinics were geocoded to the continental United States. Eighteen states (37 percent) had no retail clinics, and 17 states (35 percent) had 25 or more clinics," the authors write. Five states had more than 50 clinics including Florida (112), California (90), Texas (85), Illinois (58) and Georgia (56). Retail clinics were located in 908 census tracts within 247 counties. Ninety-six percent of counties with retail clinics were classified as metropolitan areas. "Counties with retail clinics had lower rates of uninsured individuals (12.1 percent vs. 13.3 percent)," the authors write. "Compared with census tracts without retail clinics, those tracts with retail clinics had a lower percentage of black and Hispanic individuals, fewer rental units and lower rates of poverty. In addition, the census tracts had residents with higher median incomes and higher rates of home ownership."
"If retail clinics are determined to be a valuable and effective source of care, rethinking the distribution of these clinics may be an important avenue for improving their potential societal benefit," the authors conclude. "With nearly a third of chain stores located in medically underserved areas, the future expansion of retail clinics into existing stores could potentially improve access for underserved populations."
Editor's Note: The Robert Wood Johnson Foundation Clinical Scholars Program at the University of Pennsylvania provided funding for this research. 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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 25, 2009
Academic Physicians Who Spend Time on Their Most Meaningful Work Pursuits Appear to Have a Lower Risk of Burnout
CHICAGO—Faculty physicians at academic medical centers may be less likely to experience burnout if they spend at least one day per week on the aspect of their work that is most meaningful to them, according to a report in the May 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. "Physicians are responsible for caring for the nation’s sick, promoting the public health, advancing the science of medicine and passing the torch of knowledge to the next generation of physicians," the authors write as background information in the article. "Unfortunately, despite the value and importance of these pursuits, an expanding body of literature reports growing personal distress among physicians and a decrease in their satisfaction with the practice of medicine. Specifically, numerous studies have documented high rates of burnout and poor mental health among U.S. physicians and have suggested that physician distress can have a profound impact on patient quality of care as well as on a physician’s personal health." In addition to factors affecting all physicians, such as increased administrative work and less time with patients, academic faculty must navigate a variety of requirements that compete for their time. Each individual physician derives varying levels of satisfaction from these components, which include research, education and administrative responsibilities. To better understand how career fit—the extent to which an individual is able to focus on those aspects they find they most meaningful—influences burnout, Tait D. Shanafelt, M.D., and colleagues at Mayo Clinic, Rochester, Minn., conducted a survey of faculty physicians in the Department of Internal Medicine at a large academic medical center in the fall of 2007. Of 556 physicians selected to participate, 465 (84 percent) returned surveys. When asked which aspect of work they found most meaningful, most (68 percent) reported patient care, whereas 19 percent selected research, 9 percent education and 3 percent administration. Overall, 34 percent of faculty members met criteria for burnout, which include emotional exhaustion, depersonalization and low personal accomplishment. A total of 385 of 437 physicians (88 percent) spent at least 20 percent (about one day per week) of their effort on the activity they reported to be most personally meaningful; those who did had about half the rate of burnout as those who spent less than 20 percent of their time on this activity (29.9 percent vs. 53.8 percent). "The association between time spent in the most meaningful activity and burnout was strong and was the largest predictor of burnout on multivariate analysis after other factors were controlled for," the authors write.
"These findings have important implications for the administrative leadership and department chairs at academic medical centers. These centers are responsible for training the next generation of physicians, for serving as the primary origin of scientific discovery and advances in the fields of medicine and health care delivery, and for providing tertiary medical care to patients with complex and unusual health care problems. Their physician faculty is the most critical resource for academic medical centers to discharge these responsibilities to society," they conclude. "Efforts to optimize career fit may promote physician satisfaction and help to reduce attrition among academic faculty physicians."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Career Fit Should Be a Goal of Academic Leaders
"The high prevalence of burnout in the academic setting (34 percent of surveyed physicians) noted by Shanafelt and colleagues requires that we pay attention," writes Mark Linzer, M.D., from the University of Wisconsin, Madison, in an accompanying editorial. "In this issue of the Archives, Shanafelt and colleagues introduce a new method to prevent burnout: maximizing career fit. How well do physicians’ career aspirations match their actual workday?"
"Determining the presence or absence of career fit in annual review meetings with faculty members is a necessary first step. Once we, as leaders, know what is required, we will need to find ways to finance the investment," Dr. Linzer concludes. "Although formal cost-effectiveness analyses have yet to be performed, Shanafelt and colleagues’ data suggest that providing an additional 10 percent of time to allow faculty physicians to pursue their career goals could have strikingly positive consequences not only for the physicians and their families but also for their learners and potentially their patients as well as for the bottom line."
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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 25, 2009
Evidence Supports Use of Web- and Computer-Based Programs to Help Adults Quit Smoking
CHICAGO—Available evidence supports the use of online or other computer-based smoking cessation programs for helping adults quit smoking, according to a meta-analysis of previously published studies appearing in the May 25 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. "Smoking is the single greatest cause of preventable disease and premature death," the authors write as background information in the article. Currently recommended smoking cessation strategies include individual or group counseling, medications and telephone quit-line counseling. Seung-Kwon Myung, M.D., M.S., then at the University of California, Berkeley, and now at the National Cancer Center, Goyang, South Korea, and colleagues identified 22 randomized controlled trials of Web- and computer-based programs published between 1989 and 2008. The trials included a total of 29,549 participants, 16,050 of whom were randomly assigned to a computer-based program and 13,499 to a control group. Ten studies used supplemental interventions—such as counseling, classroom lessons, nicotine replacement gum or patches, medication or quitlines—whereas 12 studies used Web- or computer-based programs alone. When the results of the trials were pooled and analyzed, individuals assigned to use computer- or Web-based programs were about 1.5 times more likely to quit smoking than those assigned to control groups. Abstinence rates were higher among intervention groups than control groups after six to 10 months (11.7 percent vs. 7 percent) and 12 months (9.9 percent vs. 5.7 percent) of follow-up. The effects of these programs were similar to those of counseling interventions, the authors note. "The stand-alone interventions had a significant effect on smoking cessation as well as on those that had supplemental interventions," the authors write. "However, compared with adults, these programs did not significantly increase the abstinence rate in adolescent populations."
"Our findings imply that there is sufficient evidence to support the use of a Web- or computer-based smoking cessation program for adult smokers," the authors conclude. "As global Web users continue to increase, Web-based smoking cessation programs could become a promising new strategy that is easily accessible for smokers worldwide."
Editor's Note: Dr. Myung and co-authors Dr. McDonnell, Dr. Kazinets and Dr. Moskowitz received funding from the Centers for Disease Control and Prevention. 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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