|
|
|
|
|
| ||
|
July 6, 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 PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 6, 2009)
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, July 6, 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, July 6, 2009
Sugar Substitute Appears to Prevent Early-Childhood Cavities
CHICAGO—Children given an oral syrup containing the naturally occurring sweetener xylitol may be less likely to develop decay in their baby teeth, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Early childhood caries (cavities), also called baby bottle tooth decay or nursing caries, continue to increase in prevalence, according to background information in the article. "Poor children experience rates twice as high as those of their more affluent peers, and their disease is more likely to be untreated," the authors write. "Poor oral health affects diet and nutrition and significantly diminishes quality of life. However, tooth decay is a disease that is largely preventable." Xylitol, approved in the United States for use in food since 1963, has been shown to effectively prevent tooth decay by acting as an antibacterial agent against organisms that cause cavities. These previous investigations have primarily involved chewing gum or lozenges used in school-age children with permanent teeth. Peter Milgrom, D.D.S., of the University of Washington, Seattle, and colleagues evaluated the effectiveness of applying oral syrup containing xylitol among 94 children age 9 to 15 months in the Republic of the Marshall Islands, where early childhood tooth decay is a serious health care problem. Two active treatment groups received 8 grams per day of xylitol syrup divided into two (33 children) or three (32 children) doses per day. A third, control group of 29 children received a small amount (a single 2.67-gram dose) of xylitol syrup per day because the internal review committee appointed by the secretary of health of the Republic of the Marshall Islands did not permit the use of a placebo. After an average of 10.5 months, eight of 33 children (24.2 percent) receiving two doses of xylitol per day and 13 of the 32 children (40.6 percent) receiving three doses of xylitol per day had tooth decay, compared with 15 of the 29 children (51.7 percent) in the control group. The average numbers of decayed teeth were 0.6 in the two-dose xylitol group, one in the three-dose xylitol group and 1.9 in the control group.
"Our results suggest that exposure to xylitol (8 grams per day) in a twice-daily topical oral syrup during primary tooth eruption could prevent up to 70 percent of decayed teeth," the authors write. "Dividing the 8 grams into three doses did not increase the effectiveness of the treatment. These results provide evidence for the first time (to our knowledge) that xylitol is effective for the prevention of decay in primary teeth of toddlers." More research is needed to develop vehicles and strategies for optimal public health, but in populations with high rates of tooth decay, xylitol is likely to be a cost-effective preventive measure, they conclude.
Editor's Note: This study was funded by a grant from the Health Resources and Services Administration Maternal and Child Health Bureau and by a grant from the National Institute of Dental and Craniofacial Research. Danisco USA donated the raw materials used to make the syrups in this study. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Xylitol Could Help Solve Problem of Early-Childhood Tooth Decay
"Early childhood caries is well understood by microbiologists and research dentists-if not by the general public and their health care providers-as ordinary tooth decay run amok," writes Burton L. Edelstein, D.D.S., M.P.H., of the College of Dental Medicine, Columbia University, in an accompanying editorial. "It most commonly manifests as extensive tooth destruction and associated pain, with or without infection, by age 22 months and sometimes much earlier," Dr. Edelstein continues. "The Centers for Disease Control and Prevention reports that more than one-quarter of all U.S. toddlers and preschoolers (28 percent) are affected."
"Findings reported herein by Milgrom and colleagues that xylitol application holds strong promise to significantly dampen early childhood caries occurrence are encouraging and suggest the addition of this approach to pharmacologic management in public health and individual care settings. Xylitol application, like fluoride varnish application, will likely become a routine element of early childhood caries control. The finding, however, that early childhood caries prevalence remained at 24 percent to 41 percent among treated children at the close of the trial in a high-caries-experience population reminds us that no single 'silver bullet' is going to solve the problem of early childhood caries."
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, July 6, 2009
Online Computer Games Could Encourage Children to Eat Healthy Foods
CHICAGO—Children who play an online game promoting healthy foods and beverages appear more likely to choose nutritious snacks than those who play a game promoting unhealthy products, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Obesity rates among U.S. children and youth have tripled during the past 40 years, according to background information in the article. "One potential contributor to the rise in obesity is media exposure, primarily because television advertising markets high-calorie foods and beverages that have little nutritional value," the authors write. "We know far less about how newer media influence children's food preferences, but Internet use is a very popular activity among youth aged 8 to 18 years. Marketers have taken notice of this online revenue-generating opportunity in which exposure to products costs less than traditional television advertisements and legal restrictions and regulations are virtually non-existent." Advergames-online computer games developed specifically to promote a brand, often featuring logos and characters-are present on many food and beverage Web sites. Tiffany A. Pempek, Ph.D., and Sandra L. Calvert, Ph.D., of Georgetown University, Washington, D.C., conducted a study involving 30 low-income, African American children age 9 to 10 years. One group played a game, based on Pac-Man, that rewarded them for having their computer character choose bananas, orange juice and other healthy foods and beverages. A second group played a different version of the same game that instead rewarded consumption of soda, candy bars, cookies and bags of potato chips. These two groups were instructed to select a snack from among options featured in the game after playing, whereas a third, control group selected a snack and beverage before playing the healthy version of the game. The children reported liking both versions of the game and played for an average of 9 minutes and 32 seconds. Children who played the healthy version before selecting a snack were significantly more likely than those playing the unhealthy version to choose a banana and orange juice instead of soda and potato chips. "With only 10 minutes of exposure, our results revealed that children selected and ate whatever snacks were being marketed by the advergame, healthy or not," the authors write. The findings suggest that public concerns about online games that market unhealthy foods are justified, the authors note, but also that the technology could be used to promote nutritious foods. "Eating patterns established during childhood affect health throughout the lifespan. Thus, it is important that we find ways to promote a healthy lifestyle for our children from an early age, particularly those who come from low-income neighborhoods where the risk of obesity is greatest," the authors write.
Despite concerns that low-income children do not have Internet access, children in the study reported being online daily or at least several times per week. "Overall, our results suggest that reaching low-income African American children via the Internet is feasible and that the use of advergames is a potential way to alter their eating habits in favor of more nutritious foods," the authors conclude.
Editor's Note: This study was supported by a Reflective Engagement in the Public Interest grant from Georgetown University. 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, July 6, 2009
Study Examines Association of Movie Smoking Exposure and Team Sport Participation With Youths Becoming Established Smokers
CHICAGO—Participating in team sports is associated with a reduced likelihood of youths becoming established smokers, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. However, exposure to movie smoking appears to be associated with an increased risk of established smoking in both team sport participants and nonparticipants. Past studies suggest that there is a direct association between movie smoking exposure and youth smoking initiation, with 30 percent to 50 percent of adolescents' smoking initiation attributed to movie smoking exposure, according to background information in the article. "Movie smoking exposure appears to increase the risk of smoking initiation by enhancing adolescents' perceived benefits of smoking and making them more susceptible to peer influences," the authors write. Anna M. Adachi-Mejia, Ph.D., of Hood Center for Children and Families, Dartmouth Medical School, Lebanon, N.H., and colleagues analyzed data from school- and telephone-based surveys that assessed movie smoking exposure and team sports participation in 2,048 youths from September 1999 through November 1999 and February 2006 through February 2007. Baseline movie smoking exposure was reported when respondents were ages 9 to 14 and team sport participation was assessed at ages 16 to 21 at follow-up. Movie smoking exposure was classified in quartiles with 0 to 522 smoking occurrences for the first quartile, 523-947 for the second, 948 to 1,649 for the third and 1,650 to 5,308 for the fourth. Respondents had been exposed to an average of 1,191 smoking occurrences from 601 movies at baseline with no significant difference in exposure between sports participants and nonparticipants. A total of 353 (17.2 percent) of the respondents were established smokers (having smoked 100 cigarettes or more in their lifetime) at follow-up. Those with exposure to the highest quartile of movie smoking compared to those with exposure to the lowest quartile were more likely to become established smokers. "Compared with the other respondents, established smokers were significantly more likely to be male, be older, have parents with lower levels of education, have a higher proportion of close friends who smoke, have parents who smoke, report lower school performance, have higher levels of sensation seeking and rebelliousness and be less likely to be enrolled in school at the time of follow-up," the authors write. Although team sports nonparticipants were twice as likely to become established smokers as sports participants, "in both team sports participants and nonparticipants, the proportion of established smokers increased from lowest to highest levels of movie smoking exposure by the same amount, 19.3 percent."
"In summary, this study supports the benefits of youth participation in team sports, which appears to protect against established smoking even in the face of movie smoking exposure," the authors conclude. "However, movie smoking exposure increases the risk of established smoking among both team sports participants and nonparticipants. Parents, teachers, coaches and clinicians should be aware that encouraging team sports participation in tandem with minimizing early exposure to movie smoking may offer the greatest likelihood of preventing youth smoking."
Editor's Note: The study was supported by grants from the National Cancer Institute. 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, July 6, 2009
Amino Acid May Help Treat Patients With Hair-Pulling Condition
CHICAGO—The amino acid N-acetylcysteine appears to reduce symptoms of compulsive hair-pulling in patients with a condition known as trichotillomania, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Trichotillomania has been described for almost 200 years and researched for more than two decades, but there is currently no approved treatment for the condition, according to background information in the article. "Trichotillomania is characterized by the following diagnostic criteria: the recurrent pulling out of one's hair, which results in noticeable hair loss; an increasing sense of tension immediately before pulling out the hair or when attempting to resist the behavior; and pleasure, gratification or relief when pulling out hair," the authors write. "Psychosocial problems are common in individuals with trichotillomania and include significantly reduced quality of life, reduced work productivity and impaired social functioning." The amino acid N-acetylcysteine has previously shown promise in the treatment of repetitive or compulsive disorders and acts on the glutamate system, the largest neurotransmitter system in the human brain, the authors note. Jon E. Grant, J.D., M.D., M.P.H., and colleagues at the University of Minnesota School of Medicine, Minneapolis, conducted a 12-week, double-blind controlled trial of the medication among 50 individuals with trichotillomania (45 women and five men, average age 34.3 years). Twenty-five were randomly assigned to receive 1,200 milligrams to 2,400 milligrams of N-acetylcysteine per day for 12 weeks; the other 25 received placebo. After 12 weeks, patients taking the active medication had significantly greater reductions in hair-pulling symptoms than those taking placebo. "Fifty-six percent of patients 'much or very much improved' with N-acetylcysteine use compared with 16 percent taking placebo," the authors write. "Significant improvement was initially noted after nine weeks of treatment." None of the participants reported adverse effects. The magnitude of improvement observed in patients taking N-acetylcysteine was higher than that seen with other medications and similar to that reported for cognitive behavior therapy alone or combined with medication, suggesting that N-acetylcysteine compares favorably with existing treatment options, the authors note. Its efficacy lends further support to the hypothesis that therapies manipulating the glutamate system (called glutamatergic agents) may target core symptoms of compulsive behaviors.
"N-acetylcysteine is an amino acid, is available in health-food stores, is cheaper than most insurance co-payments and seems to be well-tolerated. N-acetylcysteine could be an effective treatment option for people with trichotillomania," the authors write. Future studies should evaluate long-term effects of the treatment as well as its efficacy when combined with behavioral therapy, they conclude. "As effective treatments for hair pulling emerge, it becomes increasingly important that physicians and mental health care providers screen for trichotillomania to provide timely treatment."
Editor's Note: Dr. Grant has received research grants from the National Institute of Mental Health, Forest Pharmaceuticals, GlaxoSmithKline and Somaxon Pharmaceuticals; has been a consultant to Pfizer Pharmaceuticals and Somaxon Pharmaceuticals; and has consulted for law offices as an expert regarding impulse control disorders. 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, July 6, 2009
Family History Predicts Presence and Course of Psychiatric Disorders
CHICAGO—A family history of depression, anxiety, alcohol dependence or drug dependence is associated with the presence of each condition and also may predict its course and prognosis, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Family history of a psychiatric condition is generally known to increase an individual's risk of developing that condition, according to background information in the article. "However, there is a need to go further and test whether family history is also associated with clinical features of the disorder thought to represent a continuum of seriousness among individuals who meet criteria for diagnosis," the authors write. Barry J. Milne, Ph.D., of University of Auckland, New Zealand, and colleagues studied 981 residents of Dunedin, New Zealand, born in 1972 or 1973. Participants were enrolled in the Dunedin Study at age 3 and followed up through age 32. Between 2003 and 2005, family history data were collected about each individual's biological parents, grandparents and siblings older than 10 years. Four psychiatric disorders were studied: major depressive episode, anxiety disorder, alcohol dependence and drug dependence. "In general, we found that associations showed a consistent direction of effect across all four disorders: (1) family history was associated with the presence vs. absence of disorder for all four disorder types; (2) family history was associated with a recurrent course for all four disorders (but not significantly for women with depression); (3) family history was associated with worse impairment for all four disorders (but not significantly for depression and drug dependence); and (4) family history was associated with greater service use for all four disorders (but not significantly for anxiety disorders)," the authors write. The results suggest implications for researchers who wish to study genetic forms of a disorder and also for clinicians treating psychiatric conditions, the authors note.
From a public health perspective, family history may be useful for determining which patients will have the poorest prognosis," they conclude. "For example, among those with depression, anxiety disorder, alcohol dependence and drug dependence, a family history screen may help determine whose illness will recur, whose illness will cause the greatest impairment and who will be the most likely to use treatment resources. Thus, family history may identify a subgroup in need of primary or early intervention, and for whom treatments appropriate for recurrent, highly disabling disorder may be needed."
Editor's Note: This study was supported by grants from the National Institute of Mental Health, the Medical Research Council, the William T. Grant Foundation and the Health Research Council of New Zealand. Co-author Dr. Caspi holds a Royal Society Wolfson Merit Award. 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, July 6, 2009
Internet-Based Intervention May Improve Insomnia
CHICAGO—An online insomnia intervention based on established face-to-face cognitive behavioral therapy techniques appears to improve patients' sleep, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals. About one-third of adults report symptoms of insomnia and approximately 10 percent meet diagnostic criteria for an insomnia disorder, according to background information in the article. The condition decreases quality of life, impairs daytime functioning, has personal and public health consequences and results in an estimated $41 billion in reduced productivity every year. Cognitive behavioral therapy-a psychological treatment focusing on the behaviors and dysfunctional thoughts that contribute to sleep problems-is one of the most effective treatments for insomnia. "Unfortunately, availability of cognitive behavioral therapy is severely limited for many reasons, including lack of trained clinicians, poor geographical distribution of knowledgeable professionals, expense and inaccessibility to treatment and clinicians," the authors write. Lee M. Ritterband, Ph.D., of the University of Virginia Health System, Charlottesville, and colleagues evaluated the effectiveness of an Internet intervention based on cognitive behavioral therapy techniques among 44 adults (average age 44.9) who had a history of sleep difficulties lasting longer than 10 years on average. A total of 22 participants were randomly assigned to a control group and 22 received the Internet intervention, SHUTi. The highly interactive nine-week program uses text, graphics, animations, vignettes, quizzes and games to present behavioral, educational and cognitive techniques for improving sleep. For instance, patients were advised to avoid reading and watching television in the bedroom, stop daytime napping and change unhelpful beliefs and thoughts (including worries about the consequences of insomnia) that may exacerbate sleep difficulties. Participants completed daily sleep diaries before and after the intervention and also rated their symptoms on the seven-item Insomnia Severity Index, which produces a score from zero (no symptoms) to 28 (severe insomnia). Among individuals who received the intervention, scores on the index improved from 15.73 to 6.59, whereas scores did not change for the control group. These gains were maintained at a six-month follow-up assessment.
"An Internet intervention has the potential of meeting the large unmet treatment need of the population with insomnia by providing effective treatment through the Web," they continue. "An effective and inexpensive Internet intervention would expand treatment options for large numbers of adults with insomnia, especially those whose geographical location prohibits access to relevant care, and could be a substantive first-line treatment choice."
Editor's Note: This study was supported by a grant from the National Institute of Mental Health, National Institutes of Health. 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. |
|
|
