|
|
|
|
|
| ||
|
October 5, 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, October 5, 2009)
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 5, 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, October 5, 2009
Mediterranean Diet Associated With Reduced Risk of Depression
CHICAGO—Individuals who follow the Mediterranean dietary pattern—rich in vegetables, fruits, nuts, whole grains and fish—appear less likely to develop depression, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals. The lifetime prevalence of mental disorders has been found to be lower in Mediterranean than Northern European countries, according to background information in the article. One plausible explanation is that the diet commonly followed in the region may be protective against depression. Previous research has suggested that the monounsaturated fatty acids in olive oil—used abundantly in the Mediterranean diet—may be associated with a lower risk of severe depressive symptoms. Almudena Sánchez-Villegas, B.Pharm., Ph.D., of University of Las Palmas de Gran Canaria and Clinic of the University of Navarra, Pamplona, Spain, and colleagues studied 10,094 healthy Spanish participants who completed an initial questionnaire between 1999 and 2005. Participants reported their dietary intake on a food frequency questionnaire, and the researchers calculated their adherence to the Mediterranean diet based on nine components (high ratio of monounsaturated fatty acids to saturated fatty acids; moderate intake of alcohol and dairy products; low intake of meat; and high intake of legumes, fruit and nuts, cereals, vegetables and fish). After a median (midpoint) of 4.4 years of follow-up, 480 new cases of depression were identified, including 156 in men and 324 in women. Individuals who followed the Mediterranean diet most closely had a greater than 30 percent reduction in the risk of depression than whose who had the lowest Mediterranean diet scores. The association did not change when the results were adjusted for other markers of a healthy lifestyle, including marital status and use of seatbelts. "The specific mechanisms by which a better adherence to the Mediterranean dietary pattern could help to prevent the occurrence of depression are not well known," the authors write. Components of the diet may improve blood vessel function, fight inflammation, reduce risk for heart disease and repair oxygen-related cell damage, all of which may decrease the chances of developing depression.
"However, the role of the overall dietary pattern may be more important than the effect of single components. It is plausible that the synergistic combination of a sufficient provision of omega-three fatty acids together with other natural unsaturated fatty acids and antioxidants from olive oil and nuts, flavonoids and other phytochemicals from fruit and other plant foods and large amounts of natural folates and other B vitamins in the overall Mediterranean dietary pattern may exert a fair degree of protection against depression," the authors write.
Editor's Note: The Spanish Government Instituto de Salud Carlos III, Fondo de Investigaciones Sanitarias and the Navarra Regional Government project supported the study. 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, October 5, 2009
Cocaine Vaccine May Help Some Reduce Drug Use
CHICAGO—A vaccine to treat cocaine dependence appears to reduce use of the drug in a subgroup of individuals who attain high anticocaine antibody levels in response, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals. However, only 38 percent of vaccinated individuals produced high enough antibody levels and those who did maintained them for only two months. About 2.5 million Americans are dependent on cocaine, but only 809,000 receive treatment, according to background information in the article. One of every three drug-related emergency department visits can be attributed to cocaine dependence, which also has substantial social and economic effects. The U.S. Food and Drug Administration has not approved any pharmacological therapies for cocaine abuse, and behavioral therapies have a wide range of effectiveness. Animal and human studies have suggested that high levels of anticocaine antibodies in the blood can sequester and inactivate cocaine before it enters the brain, reducing feelings of euphoria from the drug without causing any psychoactive effects or harmful interactions. Bridget A. Martell, M.D., M.A., of Yale University School of Medicine, New Haven, and Veterans Affairs Connecticut Healthcare System, West Haven, and colleagues conducted a 24-week phase 2b trial of a vaccine designed to increase levels of cocaine antibodies in the blood. A total of 115 cocaine-dependent individuals enrolled and 58 were randomly assigned to receive five vaccinations of the active vaccine. The other 57 received placebo injections over 12 weeks. In both groups combined, 94 (82 percent) completed the trial. Three times per week for 24 weeks, participants' urine was tested for metabolized cocaine. Of the 55 participants who completed five active vaccinations, 21 (38 percent) attained blood cocaine antibody levels of 43 micrograms per milliliter or higher; those who did had significantly more cocaine-free urine samples between weeks nine and 16 of the study than individuals who did not attain those antibody levels or who received placebo injections (45 percent vs. 35 percent cocaine-free urine samples). The proportion of participants who reduced their cocaine by half was also greater in the group with high antibody levels than in those with a low antibody level (53 percent vs. 23 percent). Adverse events associated with the vaccine were mild or moderate, with the most frequent being hardening and tenderness at the injection site. No treatment-related serious adverse events, withdrawals or deaths occurred. "Optimal treatment will likely require repeated booster vaccinations to maintain appropriate antibody levels. Furthermore, efforts will be needed to retain subjects during the initial series of injections since antibody levels increased slowly over the first three months when patients were immunized according to the protocol used in these studies," the authors write. "Other treatments need to be used during this early treatment period to encourage abstinence. As an example, to retain subjects in this study during the initial slow increase in antibody responses, we enlisted cocaine-dependent subjects who were enrolled in a methadone maintenance program."
"Thus, the goals for future vaccine development will be to increase the proportion of subjects who can attain the desired antibody levels and to extend these periods of abstinence through long-term maintenance of these adequate antibody levels," they conclude. "We look forward to extending our promising findings in a broader population of cocaine abusers as we also reach for these future vaccine development goals."
Editor's Note: This work was supported by grants from the National Institute on Drug Abuse and by the Veterans Affairs Mental Illness Research, Education and Clinical Center. Dr. Martell was provided salary support by the Veteran's Affairs Office of Research and Development/Cooperative Studies Program Career Development Award. Celtic Pharmaceuticals supplied the succinylnorcocaine-recombinant cholera toxin B-subunit vaccine and gave senior author Dr. Kosten travel fees for consultative 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 5, 2009
Intensive Telephone Depression Care Program Offers Substantial Benefits at a Moderate Cost
CHICAGO—Patients who participate in a structured telephone program to manage their depression appear to experience significant benefits and only a moderate increase in health care costs when compared with those who receive usual care, according to a report in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Organized treatment programs for depression in primary care have been proven effective across a wide range of patient populations and health care systems, according to background information in the article. "Broad implementation of improved depression care programs will depend on the balance of benefits and added costs," the authors write. "Depression has large economic effects outside the health care system, including disability, lost work productivity, reduced educational attainment and relationship disruption. Ideally, decisions about the value of depression care programs should consider these broader economic effects." Gregory E. Simon, M.D., M.P.H., and colleagues at the Group Health Research Institute, Seattle, conducted a randomized trial comparing two depression care programs with continued usual care. Between November 2000 and June 2004, 600 primary care patients at seven primary care clinics within one prepaid health care plan were assigned to one of three groups. A group of 207 was assigned to telephone care management, which involved up to five outreach calls for monitoring, support, feedback and care coordination; 198 were assigned to telephone care management plus psychotherapy, which added on eight sessions of structured cognitive behavioral therapy over the phone with up to four additional reinforcement calls; and 195 were assigned to usual care. Telephone assessments were conducted periodically over 24 months, and costs were measured using health plan accounting records. Over the 24-month study, the telephone care management program led to an average gain of 29 depression-free days and a $676 increase in outpatient health care costs compared with usual care. Care management plus psychotherapy led to a gain of 46 depression-free days at a cost of $397. "Willingness to pay for time free of depression is a simple (albeit far from perfect) method for summarizing various economic benefits of improved depression care," the authors write. "Our previous research suggests that primary care patients treated for depression are on average willing to pay approximately $10 (in 2000 U.S. dollars) for an additional day free of depression." In the current study, telephone care management alone had a negative net benefit even if the cost of a depression-free day was placed at $20; however, the telephone care management plus psychotherapy program delivered a positive benefit if a depression-free day was valued at $9 or more.
"The primary goal of depression treatment is to relieve suffering and improve function, not to decrease health care costs. We certainly do not intend to imply that depression treatment is justified only if it is either cost neutral or cost saving. Our findings do, however, offer some guidance to insurers or health care systems considering efforts to improve care for depression," the authors conclude. "The balance of added benefits and added costs was more favorable for the more intensive program. Efforts to improve depression treatment in primary care should consider incorporating structured psychotherapy interventions."
Editor's Note: This work was supported by a grant from the National Institute of Mental 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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 5, 2009
Antidepressant Use During Pregnancy Associated With Some Adverse Outcomes in Newborns
CHICAGO—Exposure to a certain class of antidepressant medications during pregnancy may be associated with an increased risk of preterm birth, a low five-minute Apgar score (a measure of overall health of the baby) and admission to the neonatal intensive care unit, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. More than one in ten pregnant women are estimated to have depression, comparable in frequency and severity to postpartum depression, according to background information in the article. "Depression, antidepressants and lifestyle factors associated with depression may influence pregnancy outcomes and newborn health," the authors write. "The safety profile of antidepressant medication in pregnancy is undetermined, but depression during pregnancy can be serious and has been associated with an increased maternal mortality." A class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) have been used during pregnancy since the early 1990s and are recommended as the first choice for pregnant women in many countries. Najaaraq Lund, M.D., of the Bandim Health Project, Indepth Network, Bissau, Guinea-Bissau, and Aarhus University, Aarhus, Denmark, and colleagues studied women receiving prenatal care from 1989 to 2006. They compared birth outcomes including gestational age, birth weight and Apgar score among babies born to 329 women who were treated with SSRIs, 4,902 who had a history of psychiatric illness but were not treated with SSRIs and 51,770 who had no history of psychiatric illness. Women who took SSRIs during pregnancy gave birth an average of five days earlier and had twice the risk of preterm delivery as women with no history of psychiatric illness. Infants exposed to the medications in utero were significantly more likely than the two groups not exposed to have a five-minute Apgar score of seven or below (seven is a general indicator of good infant health) or to be admitted to the neonatal intensive care unit (NICU). Head circumference and birth weight did not differ between the three groups. SSRIs have been shown to readily cross the placenta and appear in the umbilical cord blood of infants whose mothers took them, the authors note. Several previous observations have described withdrawal symptoms in infants born after exposure to the medications. In this study, exposed infants admitted to the NICU experienced symptoms that could be due to withdrawal from or adverse effects of SSRIs, including jitteriness, seizures, respiratory problems, infections and jaundice.
"The study justifies increased awareness to the possible effects of intrauterine exposure to antidepressants," the authors conclude. "However, treatment of depression during pregnancy may be warranted and future studies need to distinguish between individual SSRIs to find the safest medication."
Editor's Note: The study was conducted at Perinatal Epidemiology Research Unit, Skejby, Denmark. Dr. Lund was supported by a one-year research scholarship from the Danish Medical Research Council. 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, October 5, 2009
Many Childhood Cancer Survivors Have Uncomplicated Pregnancies, Healthy Babies
CHICAGO—Women who survived cancer in childhood or adolescence or women whose male partner is a childhood cancer survivor do not appear to have an increased risk of major complications during pregnancy, having babies with birth defects or infant deaths, according to two reports in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. However, increased rates of preterm births and low birth weight—especially among those with certain cancers or who received certain treatments—indicate that these pregnancies and infants should be closely monitored. Chemotherapy, radiation treatment and surgery for cancer may affect the future reproduction of patients with childhood cancers, according to background information in the articles. As the number of young cancer survivors increases, identifying possible adverse outcomes among their offspring is a growing concern. In one article, Beth A. Mueller, Dr.P.H., of Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, and colleagues used cancer registries to identify women who were diagnosed with cancer from 1973 through 2000, when they were younger than 20 years. They then used linked birth records to find 1,898 infants born to these women after their cancer diagnoses. These births were compared with 14,278 among women of the same age and race who had babies the same year, but had not had cancer. Infants born to childhood cancer survivors were not at increased risk of birth defects or of death, but did have a 54 percent increased risk of being born preterm and a 31 percent increased risk of weighing less than 2,500 grams. However, these infants were not at increased risk of being small for gestational age, suggesting that size differences were not severe enough to meet criteria for this designation. The researchers also analyzed infant outcomes by the type of cancer and treatments the mother had. "Risk of preterm delivery was greatest after leukemia but also was associated with lymphoma, bone tumors, soft-tissue sarcomas and an abdominal primary cancer site. Among treatment exposures, chemotherapy was associated with a two-fold increased risk of preterm delivery, but relative risks were significantly increased for most other modalities as well," they write. Diabetes, preeclampsia and anemia occurred at similar rates in all the women. However, when groups were stratified by diagnostic and treatment characteristics, bone cancer survivors had an increased risk of diabetes, anemia was increased among those with brain tumors and cancer survivors treated with chemotherapy and a borderline higher risk for preeclampsia was observed among women who were treated with a combination of chemotherapy, surgery and radiation. "Children and adolescents with cancer can be reassured that we did not find an increased risk of malformations or infant death among their first subsequent offspring," the authors conclude. "The increased occurrence of low birth weight and preterm delivery among childhood cancer survivors and of preterm delivery among young genital tract carcinoma survivors that we and others have observed may indicate relatively less severe potential problems among offspring. However, these outcomes can still greatly affect families, are associated with significantly increased costs and indicate a need for close monitoring of pregnancies among childhood and adolescent cancer survivors." In another report published in the same issue, Eric J. Chow, M.D., M.P.H., also of Fred Hutchinson Cancer Research Center, Seattle, and the same group of colleagues used similar records to identify 470 offspring of men diagnosed with childhood cancers between 1973 and 2000. A total of 4,150 comparison fathers who were the same age and race/ethnicity and had babies born the same year, but had not been diagnosed with cancer, also were studied. Compared with infants born to men who were not cancer survivors, offspring of men with cancer had a "borderline risk" of weighing less than 2,500 grams at birth, especially if the father's cancer was diagnosed at a younger age or was treated with chemotherapy. "However, they were not at risk of being born prematurely, being small for gestational age, having malformations or having an altered male to female ratio," the authors write. "Overall, female partners of male survivors were not more likely to have maternal complications recorded on birth records vs. the comparison group," they continue. However, a higher risk of preeclampsia was associated with some cancers, especially brain tumors.
"Most pregnancies resulting in live births among partners of male childhood cancer survivors were not at significantly greater risk of complications vs. comparison subjects," the authors conclude. "However, our findings of increased low birth weight and preeclampsia associated with some diagnostic groups raises the possibility that prior cancer therapy may affect male germ cells [cells that will become sperm] with effects on female partners and progeny of male survivors."
Editor's Note: Please see the articles 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, October 5, 2009
Extremely Preterm Infants Receive More Treatments But Are No More Likely to Survive than in Previous Decade
CHICAGO—When compared with infants born between 1993 and 1995, more infants born at 22 to 24 weeks' gestation at one academic medical center in 2001 to 2003 received life-sustaining interventions but were no more likely to survive, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "For more than a decade, it has been debated whether scientific advances can continue to lower the border of viability [the gestational age at which an infant can survive] or whether this goal should even be attempted. Evidence suggests that, despite this clinical and ethical debate, extremely preterm infants are regularly resuscitated," the authors write as background information in the article. "Although recent studies report that most infants die within days after birth at the border of viability, many remain concerned that aggressive resuscitation results in prolonging death and suffering in some." Pamela K. Donohue, Sc.D., and colleagues at Johns Hopkins Children's Center, Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health, Baltimore, compared prenatal management and outcome of infants born at 22 to 24 weeks' gestation in two time periods: 1993 to 1995 (early epoch) and 2001 to 2003 (late epoch). Medical records were reviewed for resuscitation efforts, interventions in the neonatal intensive care unit (NICU), time of death and illnesses or disabilities in survivors. During the two study periods, 160 women delivered 179 infants, including 90 women who delivered 104 infants during the late epoch and 70 women who delivered 75 infants during the early epoch. Compared with the early time period, women in the later period were twice as likely to be transported to a higher level of care, 48 percent more likely to be monitored by sonogram, 60 percent more likely to receive antibiotics and 61 percent more likely to receive antenatal steroids. In addition, infants admitted to the NICU between 2001 and 2003 were more frequently provided with life-sustaining interventions—including high-frequency ventilation, chest tubes and administration of dopamine and steroids—than were those admitted between 1993 and 1995. However, the rate of death based on gestational age remained the same for infants born in both time periods. "Mortality has not changed in our hospital over the past 10 years despite escalation in care at each gestational age studied. What has changed is the length of time until death," the authors write. "Applying all available medical technology to the perinatal care of extremely premature infants prolongs but does not prevent their death."
Clinicians discussed viability (the chances for the fetus' survival) with 82 percent of parents in the late epoch and 72 percent in the early epoch. "It is evident that perinatologists worked to keep parents fully informed during both epochs," the authors write. "The gold standard for decision making is a collaborative one that balances physician, parent and fetal/infant concerns. Better understanding of the process of this decision making, and its long-term impact on families, is critical to designing further studies with the most clinically relevant outcomes."
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, October 5, 2009
Psychiatric Symptoms May Predict Internet Addiction in Adolescents
CHICAGO—Adolescents with psychiatric symptoms such as attention-deficit/hyperactivity disorder (ADHD), social phobia, hostility and depression may be more likely to develop an Internet addiction, according to a report in the October issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. Although the Internet has become one of the most significant information resources for adolescents, addiction to the Internet can negatively impact school performance, family relationships and adolescents' emotional state, according to background information in the article. "This phenomenon has been described as Internet addiction or problematic Internet use and classified as a possible behavior addiction," the authors write. Previous studies report that 1.4 percent to 17.9 percent of adolescents are addicted to the Internet in both Western and Eastern societies; therefore, there have been suggestions to add Internet and gaming addictions to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. "Identification of the risk factors for Internet addiction is therefore of clinical significance for the prevention of, and early intervention into, Internet addiction in adolescents." Chih-Hung Ko, M.D., of Kaohsiung Medical University Hospital and Kaohsiung Medical University, Kaohsiung City, Taiwan, and colleagues examined the relationship between psychiatric symptoms such as ADHD, social phobia and hostility and Internet addiction in 2,293 seventh-graders (1,179 boys and 1,114 girls) from ten junior high schools in southern Taiwan. Researchers also noted differences in the predictive value of these psychiatric symptoms between males and females. Psychiatric symptoms were determined through self-reported questionnaires. Internet addiction was assessed by the Chen Internet Addiction Scale (CIAS) at baseline and at six, 12 and 24 months with scores ranging from 26 to 104. Participants scoring 64 or higher were classified as being addicted to the Internet. Of all participants, 233 (10.8 percent) were classified as having Internet addiction and 1,929 (89.2 percent) were classified as not having an Internet addiction. The researchers report that although depression, ADHD, social phobia and hostility were found to predict the occurrence of Internet addiction in the two-year follow-up, depression and social phobia predicted Internet addiction among only female adolescents. Additionally, the most significant predictors of Internet addiction in male and female adolescents were hostility and ADHD, respectively.
"These results suggest that ADHD, hostility, depression and social phobia should be detected early on and intervention carried out to prevent Internet addiction in adolescents," the authors conclude. "Also, sex differences in psychiatric comorbidity should be taken into consideration when developing prevention and intervention strategies for Internet addiction."
Editor's Note: The study was supported by grants from the National Science Council of Taiwan. The funders had no involvement in this work. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Internet Addiction May Be a 21st-Century Epidemic
"Our culture both mandates and facilitates time spent online," write Dimitri A. Christakis, M.D., M.P.H., of the Center for Child Health, Behavior and Development, Seattle, and Megan A. Moreno, M.D., M.P.H., in an accompanying editorial. "Woven as it is into the fabric of today's society, the potential for Internet use to lead to overuse and ultimately to addiction is concerning …" "Part of the failure to recognize this potential 21st-century epidemic is the simple fact that many of us, Blackberry in hand, check e-mail more than we would like. The inherent difficulties in defining Internet addiction and our own need for rectification should not prevent us from recognizing an emerging epidemic," Dr. Christakis and Dr. Moreno continue. "As pediatricians and indeed as parents, we have all experienced the pull that the Internet can have on children."
"If all at-risk children achieve sufficient exposure to become addicted, the prevalence of Internet addiction may easily approach the 2 percent to 12 percent of children reported in other countries, quickly ranking it among the most common chronic diseases of childhood," they conclude. "Our intention in raising this concern is not to be alarmist but rather to alert pediatricians to what might become a major public health problem for the United States in the 21st century."
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. |
|
|
