JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, January 20, 2009)
JAMA NEWS RELEASES
Abnormal Heart Function Associated With Reduced Capacity For Exercise
Medication May Provide Some Benefit for Older Adults With Anxiety Disorder
Nutritional Supplementation Program Helps Prevent Weight Loss Among Children in African Country
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
Study Links Abnormalities in Heart's Pumping Function
to Decline in Exercise Capacity
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 20, 2009
Media Advisory: To contact corresponding author Patricia A. Pellikka, M.D., call Traci Klein at 507-284-5005 or email klein.traci{at}mayo.edu.
Abnormal Heart Function Associated With Reduced Capacity For Exercise
CHICAGO—Patients with abnormal diastolic function (when the heart is relaxed and expanded) in the left ventricle of the heart have a substantially lower maximum capacity for exercise, according to a study in the January 21 issue of JAMA.
Many factors, including age, female sex, body mass index and co-existing medical conditions are known to be associated with a decrease in exercise capacity. Identifying potentially reversible mechanisms underlying the decline in maximum exercise capacity could have important implications. Some research has suggested that assessing left ventricular (one of four chambers in the heart) function could be used to predict exercise capacity, according to background information in the article.
Jasmine Grewal, M.D., of Mayo Clinic, Rochester, Minn., and colleagues conducted a study to examine the relationship between left ventricular diastolic function and exercise capacity. The study included 2,867 patients undergoing exercise echocardiography (a noninvasive diagnostic procedure that uses ultrasound to study the structure and motions of the heart) with routine measurements of left ventricular systolic (contraction of the heart) and diastolic function. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity.
The researchers found that diastolic dysfunction (impaired relaxation) was strongly and inversely associated with exercise capacity. Compared with normal function, those with resting diastolic dysfunction had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity.
Other independent correlates of exercise capacity were age, female sex, and body mass index greater than 30. Compared with those with normal diastolic function, patients with diastolic dysfunction had a progressive increase in the magnitude of reduction in exercise capacity with advancing age.
"In identifying diastolic function parameters as strong correlates of exercise capacity, we have identified potentially modifiable and preventable factors in the development of exercise intolerance. It is well known that exercise training improves diastolic function in healthy individuals...," the authors write.
(JAMA. 2009;301[3]:286-294. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 20, 2009
Media Advisory: To contact Eric J. Lenze, M.D., call Diane Duke Williams at 314-286-0111 or email williamsdia{at}wustl.edu.
Medication May Provide Some Benefit for Older Adults With Anxiety Disorder
CHICAGO—Preliminary research suggests that use of the drug escitalopram provided some improvement in symptoms for older adults with generalized anxiety disorder, although the overall benefits were diminished because of nonadherence to the drug by some patients, according to a study in the January 21 issue of JAMA.
Generalized anxiety disorder (GAD), one of the most common psychiatric disorders in older adults, is defined by chronic, difficult-to-control worry and anxiety, with related symptoms such as muscle tension, sleep disturbance and fatigue. The prevalence of GAD is as high as 7.3 percent among community-dwelling older adults and even higher among primary care patients. Because the number of older adults in the U.S. is growing and there is a lack of effective treatment, GAD in older adults will become an increasing human and economic burden, according to background information in the article. Selective serotonin reuptake inhibitors (SSRIs) are effective for younger adults with GAD, but little data exist regarding the outcomes of their use by older adults.
Eric J. Lenze, M.D., of Washington University, St. Louis, and colleagues examined the effectiveness, safety, and tolerability of the SSRI escitalopram for the treatment of GAD in older adults. The study included 177 participants age 60 years or older with a diagnosis of GAD, who were randomized to receive either 10 to 20 mg/d of escitalopram (n = 85) or matching placebo (n = 92) for 12 weeks. Anxiety and other outcomes were measured using a number of assessment tools.
The researchers found that the cumulative incidence of response to treatment was higher in the escitalopram group than in the placebo group (69 percent vs. 51 percent). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning, activity limitations and impairments in role and social functioning.
In the intention-to-treat (ITT) analysis, which included those who began the trial but may have dropped out, the response was not different between groups. Of the participants who received escitalopram, 16 (18.5 percent) dropped out of the study before week 12; of the participants who received placebo, 17 (18.4 percent) dropped out before week 12.
Adverse effects of escitalopram were fatigue or sleepiness, sleep disturbance and urinary symptoms.
"The lack of efficacy of escitalopram in the ITT analysis is consistent with its overall modest efficacy, diminished further by nonadherence. Given that patients with anxiety disorders are often poorly adherent to pharmacotherapy, these negative results may more accurately portray the results of treatment in clinical settings," the authors write.
"It is important for clinicians to emphasize to their anxious older patients the need for an adequate trial in which to observe any benefits, as well as the expectation and nature of adverse effects. Given the high human and economic burden of GAD, these data should provide impetus to detect and treat this common disorder. Further study is required to assess efficacy and safety over longer treatment durations."
(JAMA. 2009;301[3]:295-303. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, January 20, 2009
Media Advisory: To contact Sheila Isanaka, B.A., call Todd Datz at 617-432-3952 or email tdatz{at}hsph.harvard.edu. To contact editorial author Lynnette M. Neufeld, Ph.D., email neufeld{at}insp.mx.
Nutritional Supplementation Program Helps Prevent Weight Loss Among Children in African Country
CHICAGO—Children in Niger who received a daily nutritional supplement for three months had a lower rate of weight loss and a reduced risk of wasting compared to children who did not receive the supplementation, according to a study in the January 21 issue of JAMA.
Wasting (defined as a certain deviation that a child's weight is from the median [midpoint] weight of a child of the same height in a reference group) is characterized by the loss of weight and muscle mass. It affects approximately 10 percent of the world's children younger than 5 years and is an important factor in the risk of disease and death among this population. Ready-to-use-therapeutic foods (RUTFs) have been shown effective in the treatment of severe and moderate wasting, according to background information in the article. These foods are energy-dense, micronutrient-enriched pastes often made up of peanuts, oil, sugar and milk powder. The effectiveness of RUTFs in preventing moderate and severe wasting in children has not been previously evaluated.
Sheila Isanaka, B.A., of the Harvard School of Public Health, Boston, and colleagues assessed the effect of a 3-month distribution of RUTF to nonmalnourished children in a region with traditionally high levels of child malnutrition and evaluated the effectiveness of a distribution of RUTF delivered at the village rather than the individual level. "The primary hypotheses were that village-level supplementation with RUTF in the months preceding the annual harvest would prevent declines in individual weight-for-height and reduce the incidence of wasting in children aged 6 to 60 months over a period of 8 months," the researchers write.
The study included 12 villages in Niger, with six being randomized to intervention and six to no intervention. Children in the six intervention villages received a monthly distribution of 1 packet per day of RUTF (500 calories per day) from August to October 2006, with 8 months of follow-up. Children in the 6 nonintervention villages received no preventive supplementation. Active surveillance for conditions requiring medical or nutritional treatment was conducted monthly in all 12 villages during the study period. The number of children with height and weight measurements in August were 3,166; October, 3,110; December, 2,936; and in February 2007, the number of children with height and weight measurements was 3,026.
The researchers found a significant difference in the rate of change in measurements of wasting over the 8-month surveillance period, with the intervention resulting in a 36 percent reduction in the incidence of wasting and a 58 percent reduction in the incidence of severe wasting. The death rate did not differ between groups, and the intervention did not effect the prevalence of malaria, diarrhea or respiratory tract infection.
"These results are applicable to other settings of acute food insecurity, where access to food is limited due to emergency or seasonal conditions and where short-term food supplementation is required for the prevention of wasting. The effectiveness of preventive supplementation with RUTF in other settings may depend on RUTF acceptability, the extent of resale after distribution, and the adequacy of the public health and nutrition systems in place," the authors write.
"The effectiveness of any intervention to prevent malnutrition, however, will ultimately depend on its consideration of the underlying causes of malnutrition, integration with other broad-based strategies to improve public nutrition, and feasibility within the resource constraints of humanitarian and public health programming."
(JAMA. 2009;301[3]:277-285. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Ready-to-Use Therapeutic Food for the Prevention of Wasting in Children
In an accompanying editorial, Lynnette M. Neufeld, Ph.D., of the Centre for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico, comments on the study by Isanaka and colleagues.
"In the nutrition literature, abundant information is available concerning the effects on nutritional outcomes of different types of nutritional supplements administered under controlled conditions. Less information is available on whether supplements provided in a program context have an effect on child nutritional status and, more importantly, the program-relevant strategies to maximize that effect. Community-based research on the effects of supplements on nutritional status in children should be designed in such a way to clearly guide policy and program design. This implies going beyond individual outcomes to a more integrated approach considering acceptance, use, effects, cost, and cost-effectiveness of the supplements compared with alternative approaches."
(JAMA. 2009;301[3]:327-328. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
Study Links Abnormalities in Heart's Pumping Function
to Decline in Exercise Capacity
INTRO:
Wrinkles and gray hair may be the tell-tale signs of od age, but it's a person's inability to exercise that can impact how well they function in their golden years. A new study reveals that abnormalities in how the heart pumps blood may be one cause of a body's slowdown. Haley Weldon explains in this week's JAMA Report.
VIDEO:
B-ROLL
People exercising
AUDIO:
FROM STRONGER MUSCLES TO A HEALTHIER BODY, WE ALL KNOW THAT EXERCISING HAS MANY BENEFITS. UNFORTUNATELY, AS OUR AGE ADVANCES, OUR ABILITY TO EXERCISE TYPICALLY DIMINISHES.
VIDEO:
SOT/FULL
Super @ :11
Patricia Pellikka, M.D.
Professor of Medicine, Mayo Clinic
AUDIO:
Runs: :11
This is a major cause of disability and decline in functional capacity as patients' age.
VIDEO:
SOT/FULL
Super @ :28
Garvan Kane, M.D.
Asst. Professor of Medicine, Mayo Clinic
AUDIO:
Runs: :10
...the ability of a patient to exercise is important for a whole variety of things but essentially, it's a major determinate of quality of life.
VIDEO:
B-ROLL
Dr. Pellikka walking down hall, in echocardiography lab
AUDIO:
EXERCISE CAPACITY IS OFTEN LINKED TO AN INEVITABLE DECLINE IN MAXIMAL HEART RATE OVER TIME. BUT PATRICIA PELLIKKA, PROFESSOR OF MEDICINE AT THE MAYO CLINIC, AND HER COLLEAGUES, UTILIZED THE LATEST TECHNOLOGY TO EXPLORE HOW DIFFERENT FEATURES OF HEART FUNCTION MAY IMPACT A PERSON'S ABILITY TO EXERCISE, IN HOPES OF IDENTIFYING POTENTIALLY REVERSIBLE FACTORS.
VIDEO:
SOT/FULL
Patricia Pellikka, M.D.
AUDIO:
Runs: 11
We use high-frequency sound waves and bounce them off the blood and off the heart muscle itself and the sound waves are reflected back to the transducer
VIDEO:
GXF/JAMA COVER
B-ROLL
Echocardiogram lab
AUDIO:
THE STUDY, FEATURED THIS WEEK IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, FOCUSED ON MEASURING THE RELAXATION PHASE OR DIASTOLIC FUNCTION OF THE LEFT VENTRICLE (THE HEART'S MAIN PUMPING CHAMBER) IN OVER 2800 PATIENTS WHO WERE ALREADY UNDERGOING AN EXERCISE "STRESS TEST". THE RESULTS WERE CLEAR.
VIDEO:
SOT/FULL
Patricia Pellikka, M.D.
AUDIO:
Runs: :16
...Abnormalities in the relaxation function of the heart, or diastolic function, became more pronounced with aging. And these, the impact of these on the exercise capacity was more pronounced with aging.
VIDEO:
SOT/FULL
Garvan Kane, M.D.
AUDIO:
Runs :12
...we were surprised by the impact that it certainly has, the degree that it explains how much poor exercise performance may be related to problems with relaxation of the heart.
VIDEO:
B-ROLL
Dr. Pellikka in her office with a patient
People exercising
AUDIO:
UTILIZING THIS KNOWLEDGE TO TRY AND PREVENT THE DEVELOPMENT OF THIS CONDITION, SOMETIMES CAUSED BY HIGH BLOOD PRESSURE AND CORONARY ARTERY DISEASE, JUST MAY KEEP PEOPLE EXERCISING LONGER. HALEY WELDON, THE JAMA REPORT.
