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September 7, 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 GENERAL PSYCHIATRY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 7, 2009)
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 7, 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, September 7, 2009
Soldiers Who Have Intense or Traumatic Combat Experiences Exhibit Evidence of Cognitive Changes
CHICAGO—In a study of whether neuropsychological changes occur following deployment to war zones, post-traumatic stress disorder appeared to be associated with attention deficits in soldiers one year after returning from Iraq, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals. In addition, intense combat experiences were associated with faster reaction times regardless of how recently a soldier was deployed. Previous research has suggested that as soldiers face prolonged stressful and life-threatening situations, changes in their brains direct their cognitive (thinking, learning and memory) resources toward survival, according to background information in the article. For instance, they may respond to dangerous events more quickly while losing the ability to pay attention, learn and remember events not related to combat. "However, it remains unknown whether deployment-related neuropsychological changes persist over time, are associated with stress-related factors (e.g., combat intensity, posttraumatic stress disorder [PTSD] symptoms and depressive reactions) or are better accounted for by demographic and contextual variables," the authors write. Brian P. Marx, Ph.D., of Veterans Affairs Boston Healthcare System and Boston University School of Medicine, and colleagues studied 268 male and female regular active-duty soldiers who served between 2003 and 2006. All the soldiers were given neuropsychological tests measuring response time, attention and memory before and after deployment. A group of 164 was assessed both immediately and one year following their return, whereas a second group of 104 returned more recently and were assessed before deployment and then a median (midpoint) of 122 days after returning. The assessments also documented demographic and military information, risk factors for neuropsychological disorders and combat intensity and emotional distress. "Greater PTSD symptoms were associated with poorer attention in soldiers tested at one-year follow-up but not in recently returned soldiers," the authors write. "Greater combat intensity was associated with enhanced reaction time, irrespective of time since return." Neither depression nor risk-related variables such as alcohol use and head injury were associated with changes in neuropsychological functioning. "Recent findings reveal notably high rates of poor mental health outcomes among U.S. service members upon return from Iraq deployment," the authors write. "Our findings additionally highlight the neuropsychological consequences of chronic PTSD symptoms. Although neuropsychological changes were not profound and, for reaction time, can be construed as desirable in the short term, their significance lies in the demonstration that psychiatric symptoms often reflect more extensive biological changes, including those affecting brain functioning."
"A growing literature demonstrates the significant impact of prolonged and repetitive stress on health factors (e.g., immune functioning, cardiovascular disease and other systemic medical illnesses) that can be traced to the biological stress response. Thus, subtle cognitive changes (positive or negative) associated with combat exposure or PTSD may represent a warning sign relevant to long-term health."
Editor's Note: This work was supported by U.S. Army Medical Research and Materiel Command and Veterans Affairs Clinical Sciences Research and Development awards. This work was also supported in part by resources provided by the South Central Mental Illness Research, Education and Clinical Center and U.S. Army Research Institute for Environmental Medicine. 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, September 7, 2009
Study Examines Association Between Childhood Bullying and Later Psychiatric Hospitalization, Treatment
CHICAGO—Childhood bullying and victimization appear to predict future psychiatric problems in both males and females although females appear more likely to be affected regardless of pre-existing psychiatric problems, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals. "Bullying can be defined as an aggressive act embodying an imbalance of power in which the victims cannot defend themselves accompanied by an element of repetition," according to background information in the article. "Bullying and victimization are associated with poorer family functioning, interparental violence and parental maltreatment" and often result in troubled outcomes for both bullies and victims. Although there have been studies on the effects of bullying, "there are no previous population-based studies that examined late adolescence or adulthood outcomes of childhood bullying among both males and females." Andre Sourander, M.D., Ph.D., of Turku University Hospital, Turku, Finland, and colleagues studied associations between bullying and victimization in childhood (at age 8) and later psychiatric hospitalization and treatment with antipsychotic medication (from ages 13 to 24) in 5,038 Finnish children who participated in the nationwide Finnish 1981 Birth Cohort Study. Information was gathered from parents, teachers, participants' self-reports and a national register of hospital and medication records. In total, 6 percent of 8-year-old boys bullied others frequently, but were not victims themselves, while 6.4 percent of boys were frequently victims but not bullies. Additionally, 2.8 percent of boys were frequently both bullies and victims. Among girls, 3.6 percent were frequent victims of bullying, 0.6 percent were bullies and 0.2 percent were both bullies and victims. "Frequent victim status at age 8 years among females independently predicted psychiatric hospital treatment and use of antipsychotic, antidepressant and anxiolytic drugs" regardless of psychiatric problems at baseline, the authors write. "Among males, frequent bully-victim and bully-only statuses predicted use of antidepressant and anxiolytic drugs. Frequent bully-victim status among males also predicted psychiatric hospital treatment and use of antipsychotics. However, when the analysis was controlled with total psychopathology score at age 8 years, frequent bully, victim or bully-victim status did not predict any psychiatric outcomes among males." Bullying behavior should be considered an indicator of the risk of a future psychiatric disorder, which may develop into a serious problem for those involved and for society in general, the authors note.
"Developing prevention systems requires a knowledge of the biological, psychological and social mechanisms involved. As later psychological disorders have been found to be associated with individuals displaying childhood bullying behaviors, there is a need for the integration of mental health services into the school context," the authors conclude. "It is important to inform policymakers, school professionals and the public about the potential short-term and long-term consequences of bullying and victimization."
Editor's Note: This study was supported by a grant from the Finnish National Social Insurance Institution and the Sigrid Juselius Foundation, Finland. 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, September 7, 2009
Severity, Duration of Depression Associated With Risk of Death Among Patients With Coronary Heart Disease
CHICAGO—Among patients with both major depression and acute coronary syndrome, those with more severe depression within a few weeks of hospitalization for a cardiac event and those whose depression does not improve within six months appear to have more than double the risk of dying over a seven-year period, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals. About one-fifth of individuals experience major depression in the first few weeks following a heart attack, according to background information in the article. Depression is associated with an increased risk of death after acute coronary syndrome, a term for cardiac events such as heart attack or unstable angina (chest pain). Alexander H. Glassman, M.D., of Columbia University Medical Center and New York State Psychiatric Institute, New York, observed participants in a study assessing the safety and effectiveness of antidepressants following heart attack (the Sertraline Antidepressant Heart Attack Randomized Trial, or SADHART) to establish features of major depression associated with long-term risk of death. A total of 361 participants who were hospitalized for acute coronary syndromes between 1997 and 1999 and determined to have major depression were tracked through September 2007. During a median (midpoint) of 6.7 years of follow-up, 75 participants (20.9 percent) died. Severity of depression during hospitalization for acute coronary syndromes was strongly associated with a significantly increased risk of death. Regardless of whether they took antidepressants, those whose depression had improved substantially at six months had significantly lower death rates—33 of 211 patients (15.6 percent) who were very much or much improved died, compared with 42 of 148 patients (28.4 percent) whose depression showed little or no improvement. Risk of death during the study period did not appear to be associated with whether patients had previous episodes of depression, whether their depression developed before or after their cardiac event or whether they took antidepressants during the first six months following hospitalization.
"Depression is a syndrome with multiple pathways to a similar clinical picture. In patients with active coronary heart disease, it seems likely that the association with depression is a two-way street, and each can aggravate the other," they conclude. "Because persistent depression increases mortality and decreases medication adherence, physicians need to aggressively treat depression and be diligent in promoting adherence to guideline cardiovascular drug therapy."
Editor's Note: This research was funded by a grant from the National Heart, Lung and Blood Institute of the National Institutes of Health; by the National Alliance for Research in Schizophrenia and Depression; by the Suzanne C. Murphy Foundation; and by the Thomas and Caroline Royster Research Fund. 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, September 7, 2009
Genetic Variations May Underlie Multiple Psychiatric Conditions
CHICAGO—Similar submicroscopic variations and rearrangements appear in the genetic material of individuals with schizophrenia, autism and mental retardation, suggesting that the three disorders may share a developmental pathway, according to a report in the September issue of Archives of General Psychiatry, one of the JAMA/Archives journals. New technologies to compare genomes have enabled researchers to detect genetic alterations known as copy number variations—deletions or duplications that change the number of copies of specific DNA segments, according to background information in the article. "Recently, this approach has been widely used in neurologic and psychiatric disorders, including mental retardation, autism spectrum disorders and schizophrenia," the authors write. "Findings from these studies suggested that several genes involved in similar neurodevelopmental pathways may be associated with these conditions. However, so far only rare structural variants, sometimes present in a single case, have been identified." Audrey Guilmatre, Ph.D., of Institut Hospitalo-Universitaire de Recherche Biomédicale, Rouen, France, and colleagues analyzed genetic material from 247 individuals with mental retardation, 260 with autism spectrum disorders, 236 with schizophrenia and 236 controls with no psychiatric diagnoses. They focused on 28 candidate loci (points on a chromosome where a gene is located) found to be associated with these conditions in previous studies. Among the 743 individuals with one of the disorders, recurrent or overlapping copy number variations were found in 11 of the 28 candidate loci (39.3 percent). One of the 28 variations was found in 10 of 236 individuals with schizophrenia (4.2 percent), 16 of 260 individuals with autism spectrum disorders (6.2 percent) and 13 of 247 cases with mental retardation (5.3 percent), compared with one of 236 controls (0.4 percent). Only one copy number variation—related to autism spectrum disorders—was potentially found to be more specifically associated with one condition as opposed to all three. In addition, many of the individuals with a copy number variation had more than one disorder; one-third of those with schizophrenia and 83.3 percent of those with autism also had a level of cognitive functioning placing them in the range of mental retardation.
The study "confirms and extends recent evidence suggesting that many candidate copy number variations are not disease specific but are involved in the expression of different behavioral phenotypes, including mental retardation, autism spectrum disorders and schizophrenia. This implies the existence of shared biologic pathways in these three neurodevelopmental conditions," the authors conclude. These pathways appear to affect the formation and maintenance of the synapses or gaps between nerve cells, as well as the function of specific neurotransmitters. "The dysfunction of specific neuronal networks underlying the particular symptoms of each clinical condition most likely depends on additional genetics, epigenetics and environmental factors that remain to be characterized."
Editor's Note: This study was supported by the Fondation de France, by Collaborative Biologic Resources From the Autism Foundation (RBCFA) and by the French Autism Foundation. 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, September 7, 2009
Community-Based Prevention System Appears to Reduce Risky Behaviors in Teens
CHICAGO—A prevention system that trains community leaders to identify and apply appropriate evidence-based programs may reduce substance use and other delinquent behaviors among adolescents, according to a report in the September issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Risky behaviors such as alcohol use, tobacco use and delinquency have large costs to society and often begin between ages 11 and 15, according to background information in the article. "The initiation of these behaviors early in adolescence is predictive of greater risk for associated health-related diseases and disorders," the authors write. "Advances in prevention science during the last two decades have produced a growing list of tested and effective programs and policies for preventing these behaviors, yet widespread dissemination and high-quality implementation of these effective programs and policies in communities has not been achieved." The Communities That Care prevention system is designed to address these issues by providing training and materials to coalitions of community stakeholders. J. David Hawkins, Ph.D., of the University of Washington, Seattle, and colleagues studied the effectiveness of the Communities That Care system in 24 small towns in seven states. In 2003, towns were matched within states and half were randomly assigned to implement the system while the other 12 towns served as controls. Coalitions in communities that implemented the system "used epidemiological data to identify elevated risk factors and depressed protective factors in the community, and chose and implemented tested programs to address their community's specific profile from a menu of effective programs for families, schools and youths aged 10 to 14 years," the authors write. The programs included school-based, community-based and family-focused programs, including Life Skills Training and Big Brothers Big Sisters. "The new programs were implemented by local providers including teachers for school programs; health and human service workers for community-based, youth-focused and family-focused programs; and community volunteers for Big Brothers Big Sisters and tutoring programs." A panel of 4,407 fifth-grade students was surveyed annually through the eighth grade. In all grades, fewer students in communities using the system were delinquent or began drinking, smoking or using smokeless tobacco than did students in control communities. Specifically, when compared with students in Communities That Care areas, students in control groups:
"This type-two translational research study indicates that public health can be promoted and health-risking behaviors in early adolescence can be prevented by coalitions of community stakeholders trained to use the Communities That Care system for translating the advances of prevention science into well-chosen and well-implemented prevention practices in communities," the authors conclude. "The Center for Substance Abuse Prevention provides Communities That Care materials electronically for downloading free of charge. However, federal resources are currently unavailable to support training and technical assistance in Communities That Care for communities that seek to use it."
Editor's Note: This study was support by a research grant from the National Institute on Drug Abuse (with co-funding from the National Cancer Institute, the National Institute of Child Health and Human Development, the National Institute of Mental Health and the Center for Substance Abuse Prevention. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Program Organizes and Delivers Effective Interventions
"Communities That Care seeks to prevent or reduce youths' involvement in illegal substance use and criminal activities through an evidence-based public health program," write Francis T. Cullen, Ph.D., of University of Cincinnati, and Cheryl Lero Jonson, M.A., in an accompanying editorial. "This program is part of a larger, though still limited, movement to develop theoretically based, empirically grounded, practical programs capable of preventing or diminishing offending behavior," they continue. "In the end, the viability of this movement will depend on generating interventions that can be shown to reduce offending and outperform punitive alternatives."
The study "holds significant implications," they conclude. "It demonstrates that Communities That Care is a conduit for organizing and then delivering effective interventions in a scientific, systematic way at the community level. Communities That Care thus is an exemplar for how to use evidence-based strategies to reduce youthful misconduct. The expanded use of this approach, especially in at-risk communities, seems worthy of further investigation."
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, September 7, 2009
Maternal Literacy Level Associated With the Cognitive Home Environment
CHICAGO—Literacy levels of low-income mothers appear to be a more accurate indicator of parenting behaviors that are important for child development than maternal educational levels, according to a report in the September issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "Children who grow up in low-income households have an increased risk of developmental delay and poor school achievement, contributing to an ongoing cycle of poverty," according to background information in the article. The cognitive home environment (provision of toys and learning materials, shared reading activities, teaching activities and verbal responsivity in the home) is an important contributing factor; "low-income families have fewer parent-child verbal interactions and less access to resources, including learning materials." Cori M. Green, M.D., M.S., of the New York University School of Medicine and Bellevue Hospital Center, New York, and colleagues analyzed results from maternal literacy tests and interviews determining maternal educational level and the cognitive home environment of 369 mother-infant pairs. Mothers were assessed during their postpartum hospital stays and when infants reached age 6 months. Literacy tests consisted of word reading skills in the mother's preferred language (English or Spanish) and were graded as reading at high school level (ninth grade or above) or lower than ninth grade. Cognitive home environment was scored using StimQ, an office-based measure with four subscales: availability of learning materials, shared reading activities, frequency and quality of teaching activities parents engage in with their children and verbal interactions between parents and their children. Mothers' average reading grade level was 12 and 34.5 percent read below the ninth grade level. "Educational and reading levels showed only small to moderate correlation; 24.1 percent of those who completed ninth grade did not read at a ninth grade level, and 43.9 percent of those who did not complete ninth grade read at ninth grade level or higher," the authors write. "Maternal literacy level of ninth grade or higher was associated with increases in scores for the overall StimQ and each of four subscales, whereas a maternal educational level of ninth grade or higher was associated with increases in scores for the overall StimQ and three of four subscales," the authors write.
Literacy may be a more precise indicator of cognitive home environment than educational level in low-income families, according to the authors. "Studies of low-income populations should therefore include direct measures of literacy level. Given the relationship between low literacy level and parenting behaviors known to be related to child outcomes, pediatricians should consider developing strategies to identify mothers with low literacy levels in order to support the cognitive home environments for children of low-literacy parents," the authors conclude.
Editor's Note: This study was supported by a grant from the National Institutes of Health/National Institute of Child Health and Human Development-funded study Promoting Early School Readiness in Primary Health Care and by the New York State Empire Clinical Research Investigators Program. 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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