|
|
|
|
|
| ||
|
November 2, 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, November 2, 2009)
ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 2, 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, November 2, 2009
Nicotine Patch Plus Lozenge Appears Best for Smoking Cessation
CHICAGO—In a comparison of five different smoking cessation medications, a nicotine patch plus a nicotine lozenge appears most effective at helping smokers quit, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals. "Many smokers have successfully quit using a variety of smoking cessation pharmacotherapies, yet there is little direct evidence on the relative efficacies of these different pharmacotherapies," the authors write as background information in the article. "Without such evidence clinicians and smokers lack a strong empirical basis for recommending or selecting among them." Megan E. Piper, Ph.D., and colleagues at the University of Wisconsin School of Medicine and Public Health, Madison, conducted a randomized clinical trial of smoking cessation therapies involving 1,504 adults. All had smoked at least 10 cigarettes a day during the previous six months and were motivated to quit. Participants were randomly assigned to one of six treatment groups: nicotine lozenge alone, nicotine patch alone, bupropion alone, patch plus nicotine lozenge, bupropion plus nicotine lozenge or placebo. Bupropion treatment began one week before a designated quit date and continued for eight weeks; all other treatments were taken for eight to 12 weeks after the quit date. All participants also received six individual counseling sessions. Smoking rates were assessed one week, eight weeks and six months after the quit date. When all the treatments were compared at the six-month point, only the individuals in the patch plus nicotine lozenge group were more successful in quitting than those taking placebo. Smokers using a patch and nicotine lozenge were also more likely to have quit at seven days and tended to have other more positive outcomes, such as a longer period of time before relapsing. In addition, this combination along with the patch alone were most effective at helping people achieve at least one day of abstinence from smoking, an important stepping stone to successful quitting. Previous research has combined the patch with other nicotine replacement therapies, such as gum, nasal spray or an inhaler. "The present results suggest that the nicotine lozenge can also be effective as an adjuvant [additional treatment] to the nicotine patch," the authors write. "The key seems to be that an ad libitum, or as needed, agent must be paired with the patch; simply using higher patch doses does not seem to augment outcomes to the same degree." The lozenge, though effective with the patch, did not appear to work any better than placebo when used alone. All of the interventions appeared safe and well tolerated, the authors note. Only four of 1,504 participants withdrew from the study for medication-related reasons.
"These findings plus recent meta-analyses published in the 2008 Public Health Service Guideline Update suggest that a combination pharmacotherapy comprising the nicotine patch and an ad libitum nicotine replacement therapy should be routinely considered for use as a smoking cessation treatment," the authors write. "In addition, this study illustrates that after more than 20 years the patch remains a highly efficacious pharmacotherapy for helping people quit smoking."
Editor's Note: This research was conducted at the University of Wisconsin-Madison and was supported by a grant from the National Institute on Drug Abuse and a grant from the General Clinical Research Centers Program of the National Center for Research Resources. Dr. Piper was supported by an Institutional Clinical and Translational Science Award, University of Wisconsin-Madison. Medication was provided to patients at no cost under a research agreement with GlaxoSmithKline. 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, November 2, 2009
Genes and Environment May Interact to Influence Risk for Post-Traumatic Stress Disorder
CHICAGO—Individuals who experience both childhood adversity and traumatic events in adulthood appear more likely to develop post-traumatic stress disorder than those exposed to only one of these types of incidents, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals. In addition, the risk was further increased in individuals with a certain genetic mutation. Although 40 percent to 70 percent of Americans have experienced traumatic events, only about 8 percent develop PTSD during their lifetimes, according to background information in the article. PTSD is a complex anxiety disorder that involves re-experiencing, avoidance and increased arousal following exposure to a life-threatening event. "In addition to the obvious effect of environmental factors, PTSD has a heritable component," the authors write. Recent studies estimate that genetic factors account for approximately 30 percent of the difference in PTSD symptoms. Pingxing Xie, B.S., of Yale University School of Medicine, New Haven, Conn., and VA Connecticut Healthcare Center, West Haven, and colleagues studied 1,252 individuals who had experienced childhood adversity (including abuse or neglect), adult trauma (such as combat, sexual assault or a natural disaster) or both. Participants age 17 to 79 (average age 38.9) were interviewed and assessed for a variety of psychiatric and substance use disorders. DNA was extracted and used to differentiate between versions of a particular polymorphism or gene mutation—known as the 5-HTTLPR genotype—previously found to be associated with emotional response after stressful life events. About one-fifth of the participants (229, or 18.3 percent) met criteria for PTSD. A total of 552 of the 1,252 participants (44.1 percent) experienced both childhood adversity and traumatic events in adulthood. These individuals were more likely to have a lifetime diagnosis of PTSD than were those who experienced trauma in only one life stage (29 percent vs. 9.9 percent). "Although the 5-HTTLPR genotype alone did not predict the onset of PTSD, it interacted with adult traumatic events and childhood adversity to increase the risk for PTSD, especially for those with high rates of both types of trauma exposure," the authors write. The genotype may influence the way the brain processes the neurotransmitter serotonin, affecting an individual's anxiety levels and changing the way neurons react to fearful stimuli, they note.
"It was only in the group of subjects who could be characterized as having had the highest rates of trauma exposure (i.e., in both childhood and adulthood) that an impact of 5-HTTLPR could be detected," the authors conclude. "This suggests that there may be many neurobiological (including genetically determined) 'buffers' to PTSD; only in instances of extreme and/or repeated trauma exposure (which, it should be pointed out, characterizes those trauma 'types' with the highest conditional risk for PTSD, e.g., domestic violence and military combat), in which these buffers are overwhelmed, can the impact of specific genes such as 5-HTTLPR be detected."
Editor's Note: This work was supported by National Institutes of Health grants. 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, November 2, 2009
High Blood Pressure and Markers of Inflammation in Blood More Common in Offspring of Parents With Alzheimer's Disease
CHICAGO—High blood pressure, evidence of arterial disease and markers of inflammation in the blood in middle age appear more common in individuals whose parents have Alzheimer's disease than in individuals without a parental history of the condition, according to a report in the November issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Previous twin studies estimate that as much as 60 percent of the risk for Alzheimer's disease is under genetic control, according to background information in the article. Other research has identified several vascular and inflammatory risk factors in midlife that may be associated with the later transition into cognitive decline related to Alzheimer's disease. Eric van Exel, M.D., Ph.D., of VU University Medical Center, Amsterdam, and colleagues compared some of these vascular and inflammatory factors, such as high blood pressure and levels of pro-inflammatory proteins known as cytokines in the blood, between 206 offspring of 92 families with a history of Alzheimer's disease and 200 offspring of 97 families without a parental history. Researchers measured blood pressure; obtained blood samples to assess genetic characteristics and levels of cholesterol, along with cytokines and other inflammation-related substances; and collected sociodemographic characteristics, medical history and information about diet, exercise and stress levels. More individuals whose parents had Alzheimer's disease carried the APOE e4 gene, known to be associated with the condition, than did those with no family history (47 percent vs. 21 percent). In addition, those with a family history had higher systolic (top number) and diastolic (bottom number) blood pressures, a lower ankle brachial index (ratio of ankle to arm systolic blood pressure, a sign of artery disease) and higher levels of several different pro-inflammatory cytokines. Other cardiovascular risk factors—such as high blood cholesterol and glucose levels—were not associated with parental Alzheimer's disease. These other components may not be as closely linked to cognitive decline, the authors write.
"Our study shows that high blood pressure and an innate pro-inflammatory cytokine response in middle age significantly contribute to Alzheimer's disease," they continue. "As these risk factors cluster in families, it is important to realize that early interventions could prevent late-onset Alzheimer's disease. One could argue for a high-risk-prevention strategy by identifying the offspring of patients with Alzheimer's disease, screening them for hypertension and vascular factors and implementing various (non)pharmacological health measures."
Editor's Note: This research project was supported by a grant from the National Institute of Aging, a grant from the European Union project LifeSpan and the Internationale Stichting Alzheimer Onderzoek (International Foundation for Alzheimer Research, the Netherlands). 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, November 2, 2009
TV Exposure May Be Associated With Aggressive Behavior in Young Children
CHICAGO—Three-year-old children who are exposed to more TV appear to be at an increased risk for exhibiting aggressive behavior, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "Early childhood aggression can be problematic for parents, teachers and childhood peers and sometimes is predictive of more serious behavior problems to come, such as juvenile delinquency, adulthood violence and criminal behavior," according to background information in the article. Various predictive factors for childhood aggression have been studied. These include parents' discipline style, neighborhood safety and media exposure. "After music, television is the medium children aged 0 to 3 years are exposed to the most." Although the American Academy of Pediatrics recommends no screen media for children younger than age 2, studies have found consistent use of television in that age group. Jennifer A. Manganello, Ph.D., M.P.H., of University at Albany, State University of New York, Rensselaer, and Catherine A. Taylor, Ph.D., M.S.W., M.P.H., of Tulane University School of Public Health and Tropical Medicine, New Orleans, collected data from 3,128 mothers of children born from 1998 to 2000 in 20 large U.S. cities to examine associations of child television exposure and household television use with aggressive behavior in children. Parents were interviewed at the time of the child's birth and at one and three years. At three years, they were asked to report time the child spent watching TV directly as well as household TV use on a typical day. Aggression was assessed using a 15-item aggressive subscale for 2- and 3-year-old children. Demographic information and other risk factors for aggression were also noted. About two-thirds (65 percent) of mothers reported that their child watched more than two hours of television per day. On average, children were exposed to an additional 5.2 hours of household TV use per day. Direct child TV exposure and household TV use were both significantly associated with childhood aggression, after accounting for other factors such as parent, family, neighborhood and demographic characteristics. "One explanation that could link both child and household TV measures with aggression involves the parenting environment," the authors write. Households with higher rates of TV use may have fewer restrictions on children's viewing habits such as exposure to unregulated television content. Increased household television use may also affect daily routines such as eating and communication patterns and may decrease time spent on other activities.
"Current American Academy of Pediatrics recommendations mainly suggest limitations for direct child exposure to TV and other media; however, our findings suggest that additional household TV use may also be an important predictor of negative childhood outcomes, such as early childhood aggression," the authors conclude. "Future research in this area should consider inclusion of both of these TV variables along with additional parent-child interaction assessments, observational assessments when possible, quality and/or content of TV programs and longitudinal analyses."
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, November 2, 2009
Many U.S. Children May Live in Families Receiving Food Stamps
CHICAGO—Nearly half of all American children will reside in a household receiving food stamps at some point between the ages of 1 and 20, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "Research has repeatedly demonstrated that two of the most detrimental economic conditions affecting a child's health are poverty and food insecurity," the authors write as background information in the article. The receipt of food stamps serves as a marker of both, since families receiving them must have low incomes and few assets. "Understanding the degree to which American children are exposed to the risks of poverty and food insecurity across the length of childhood would appear to be an essential component of pediatric knowledge, particularly in light of the growing emphasis on the importance of community pediatrics." Mark R. Rank, Ph.D., of the George Warren Brown School of Social Work, Washington University, St. Louis, and Thomas A. Hirschl, Ph.D., of Cornell University, Ithaca, New York, analyzed 30 years of longitudinal data from a nationally representative sample of the U.S. population, the Panel Study of Income Dynamics. During household interviews conducted between 1968 and 1997, demographic and other information was collected regarding children ages 1 through 20, and families reported whether they had received food stamps over the prior year. By age 1, 12.1 percent of children had lived in households receiving food stamps; 26.1 percent had by age 5, 35.9 percent by age 10, 43.6 percent by age 15, and 49.2 percent by age 20. By age 20, in addition to nearly half receiving food stamps during at least one year of the study period, about one-third of children received them for two or more years, 28.1 percent for three or more years, 26.4 percent for four or more years and almost one-fourth (22.8 percent) for five or more years. Race, education and marital status all were associated with the receipt of food stamps among children. Black children and those who lived in households headed by adults who were unmarried or had less than 12 years of education were more likely to receive food stamps.
Poverty has been estimated to raise the direct expenditures on children's health care by approximately $22 billion per year. "American children are at a high risk of encountering a spell during which their families are in poverty and food insecure as indicated through their use of food stamps," the authors conclude. "Such events have the potential to seriously jeopardize a child's overall health."
Editor's Note: Funding for the analysis in this study was provided by a Joint Center for Poverty Research Development Grant, Northwestern University/University of Chicago. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Pediatricians Must Advocate for Children's Interests
"This experience with the Food Stamp Program/Supplementary Nutritional Assistance Program reflects the broader fact that a large portion of American families rely on safety net programs for the necessities of life," writes Paul H. Wise, M.D., M.P.H., of Lucile Packard Children's Hospital and Stanford University, Stanford, Calif., in an accompanying editorial. "The paradox at the heart of our current safety net system is that the economic conditions generating the growing need for services are, at the same time, also undermining our collective ability to provide them," Dr. Wise writes. "The bottom line is that the current recession is likely to generate for children in the United States the greatest level of material deprivation that we will see in our professional lifetimes. The recession is harming children by both reducing the earning power of their parents and the capacity of the safety net to respond."
"However, it is also essential to recognize that children have been made extremely vulnerable to this recession by a decades-long deterioration in their social position," Dr. Wise continues. "In response, the pediatric community will have to address the enhanced needs of patients, strengthen its capability to take collective action and invigorate its voice in public discourse."
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, November 2, 2009
Study Examines Associations Between Antibiotic Use During Pregnancy and Birth Defects
CHICAGO—Penicillin and several other antibacterial medications commonly taken by pregnant women do not appear to be associated with many birth defects, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. However, other antibiotics, such as sulfonamides and nitrofurantoins, may be associated with several severe birth defects and require additional scrutiny. Treating infections is critical to the health of a mother and her baby, according to background information in the article. Therefore, bacteria-fighting medications are among the most commonly used drugs during pregnancy. Although some classes of antibiotics appear to have been used safely during pregnancy, no large-scale studies have examined safety or risks involved with many classes of antibacterial medications. Krista S. Crider, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed data from 13,155 women whose pregnancies were affected by one of more than 30 birth defects (cases). The information was collected by surveillance programs in 10 states as part of the National Birth Defects Prevention Study. The researchers compared antibacterial use before and during pregnancy between these women and 4,941 randomly selected control women who lived in the same geographical regions but whose babies did not have birth defects. Antibacterial use among all women increased during pregnancy, peaking during the third month. A total of 3,863 mothers of children with birth defects (29.4 percent) and 1,467 control mothers (29.7 percent) used antibacterials sometime between three months before pregnancy and the end of pregnancy. "Reassuringly, penicillins, erythromycins and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects," the authors write. Two defects were associated with erythromycins (used by 1.5 percent of the mothers whose children had birth defects and 1.6 percent of controls), one with penicillins (used by 5.5 percent of case mothers and 5.9 percent of controls), one with cephalosporins (used by 1 percent of both cases and controls) and one with quinolones (used by 0.3 percent of both cases and controls). Two medications—sulfonamides and nitrofurantoins (each used by 1.1 percent of cases and 0.9 percent of controls)—were associated with several birth defects, suggesting that additional study is needed before they can be safely prescribed to pregnant women.
"Determining the causes of birth defects is problematic," the authors write. "A single defect can have multiple causes, or multiple seemingly unrelated defects may have a common cause. This study could not determine the safety of drugs during pregnancy, but the lack of widespread increased risk associated with many classes of antibacterials used during pregnancy should be reassuring."
Editor's Note: The National Birth Defects Prevention Study is funded by a cooperative agreement 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. |
|
|
