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, February 24, 2009)
JAMA NEWS RELEASES
Women With Diabetes Before or During Pregnancy At Significantly Increased Risk of Experiencing Depression
Guidelines For Treating Patients With Cardiovascular Disease Often Based on Weaker Evidence
Most Prison Inmates With HIV Do Not Receive Appropriate Treatment Immediately Following Release
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
NEW STUDY SHOWS A NEARLY TWO-FOLD RISK OF PERINATAL DEPRESSION IN LOW-INCOME WOMEN WITH DIABETES
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TV Note: This week's JAMA Report video is on the risk of depression during and after pregnancy for women with diabetes. The report will be fed Tuesday, February 24, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 24, 2009
Media Advisory: To contact corresponding author Bernard L. Harlow, Ph.D., call Laura Stroup at 612-624-5680 or email stro0481{at}umn.edu.
Women With Diabetes Before or During Pregnancy At Significantly Increased Risk of Experiencing Depression
CHICAGO—Low-income pregnant women and new mothers with diabetes have nearly twice the risk of experiencing depression during and after pregnancy than women without diabetes, according to a study in the February 25 issue of JAMA.
Depression during the perinatal period (often considered as the last several months of pregnancy and the year following childbirth) affects at least 10 percent to 12 percent of new mothers, and approximately 2 percent to 9 percent of pregnancies are complicated by diabetes, according to background information in the article. Prior studies have established an association between diabetes and depressive disorders in general adult populations.
Katy Backes Kozhimannil, M.P.A., of Harvard Medical School and Harvard Pilgrim Health Care, Boston, and colleagues examined the association between diabetes and depression in the perinatal period among low-income women. The researchers used data from New Jersey's Medicaid administrative claims database, and included 11,024 women who gave birth between July 2004 and September 2006, and who were continuously enrolled in Medicaid for 6 months prior to delivery and 1 year after giving birth.
The researchers found that women with any form of diabetes were significantly more likely to experience some indication of depression during pregnancy or postpartum. After controlling for the effects of age, race, year of delivery, and preterm birth, women with diabetes had nearly double the odds of having a depression diagnosis or taking an antidepressant medication during the perinatal period (15.2 percent) compared with those who had no indication of diabetes (8.5 percent). This association remained consistent across the various types of diabetes.
Among women with no indication of depression during pregnancy, those with diabetes had higher odds of experiencing new onset depression during the postpartum period (9.6 percent) compared with those without diabetes (5.9 percent).
"Pregnancy and the postpartum period represent a time of increased vulnerability to depression. Treatable, perinatal depression is underdiagnosed, and it is important to target detection and support efforts toward women at high risk," the authors write.
"...studies designed to test the impact of interventions that target those most vulnerable to depression during the perinatal period could provide helpful input to policy making. Among all women with depression, diabetes, or other mental or physical health conditions that complicate the normal course of pregnancy and postpartum recovery, careful monitoring and appropriate treatment are critical to ensuring the health of the mother and her child."
(JAMA. 2009;301[8]:842-847. 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, February 24, 2009
Media Advisory: To contact Pierluigi Tricoci, M.D., M.H.S., Ph.D., call Michelle Gailiun at 919-660-1306 or email michelle.gailiun{at}duke.edu. To contact editorial co-author Terrence M. Shaneyfelt, M.D., M.P.H., call Jeff Hester at 205-933-8101, ext. 4744, or email jeffrey.hester{at}va.gov.
Guidelines For Treating Patients With Cardiovascular Disease Often Based on Weaker Evidence
CHICAGO—An examination of clinical practice guidelines for treating cardiovascular disease finds that current recommendations are largely based on lower levels of evidence or expert opinion, according to a study in the February 25 issue of JAMA.
Clinical practice guidelines are developed to assist practitioners with decisions about appropriate health care for specific patients' circumstances, and are often assumed to be the standard of evidence-based medicine, according to background information in the article.
For more than 20 years, the American College of Cardiology (ACC) and the American Heart Association (AHA) have released clinical practice guidelines to provide recommendations on care of patients with cardiovascular disease. The ACC/AHA guidelines currently use a grading scheme based on level of evidence and class of recommendation. The level of evidence classification combines an objective description of the existence and the types of studies supporting the recommendation and expert consensus, and are categorized as A (higher level of evidence), B, or C [lower level of evidence).
The class of recommendation designation indicates the strength of a recommendation and requires guideline writers not only to make a judgment about the relative strengths and weaknesses of the study data but also to make a value judgment about the relative importance of the risks and benefits identified by the evidence. Classes include I (evidence that a treatment or procedure is effective), II, IIa, IIb and III (evidence that a treatment or procedure is not effective).
Whether the increase in publication of studies concerning cardiovascular disease has resulted in guideline recommendations with more certainty and supporting evidence is not known. Pierluigi Tricoci, M.D., M.H.S., Ph.D., of Duke University, Durham, N.C., and colleagues examined the changes in recommendations in ACC/AHA cardiovascular guidelines and evaluated the adequacy of evidence behind current guideline recommendations. The analysis included data from ACC/AHA practice guidelines issued from 1984 to September 2008. Fifty-three guidelines on 22 topics, including a total of 7,196 recommendations, were examined.
Considering only the current guidelines with at least 1 revision, the total number of recommendations has increased from 1,330 to 1,973 (48 percent increase) from the first guideline to the current version. Overall, the guidelines shifted to more class II recommendations and fewer class III recommendations, while the use of class I recommendations remained fairly constant over time. The 16 current guidelines reporting levels of evidence, comprising a total of 2,711 recommendations, classify 314 recommendations as level of evidence A (median [midpoint], 11 percent), and 1,246 with level of evidence C (median, 48 percent).
Among all 1,305 class I recommendations of guidelines reporting level of evidence, only 245 have level of evidence A (median, 19 percent), with 481 (median, 36 percent) having a level of evidence C. Level of evidence significantly varies across categories of guidelines (disease, intervention, or diagnostic) and across individual guidelines.
"Our finding that a large proportion of recommendations in ACC/AHA guidelines are based on lower levels of evidence or expert opinion highlights deficiencies in the sources of definitive data available for the generation of cardiovascular guidelines. To remedy this problem, the medical research community needs to streamline clinical trials, focus on areas of deficient evidence, and expand funding for clinical research. In addition, the process of developing guidelines needs to be improved with information about the impact that recommendations based on lower levels of evidence has on clinical practice. Finally, clinicians need to exercise caution when considering recommendations not supported by solid evidence," the authors conclude.
(JAMA. 2009;301[8]:831-841. 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: Reassessment of Clinical Practice Guidelines — Go Gently Into That Good Night
In an accompanying editorial, Terrence M. Shaneyfelt, M.D., M.P.H., and Robert M. Centor, M.D., of the University of Alabama School of Medicine, Birmingham, write that if clinical practice guidelines are going to continue to exist, they need to undergo major changes.
"However, it seems unlikely that substantial change will occur because many guideline developers seem set in their ways. If all that can be produced are biased, minimally applicable consensus statements, perhaps guidelines should be avoided completely. Unless there is evidence of appropriate changes in the guideline process, clinicians and policy makers must reject calls for adherence to guidelines. Physicians would be better off making clinical decisions based on valid primary data."
(JAMA. 2009;301[8]:868-869. 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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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 24, 2009
Media Advisory: To contact Jacques Baillargeon, Ph.D., call Marsha Canright at 409-772-8785 or email mwcanrig{at}utmb.edu.
Most Prison Inmates With HIV Do Not Receive Appropriate Treatment Immediately Following Release
CHICAGO—Approximately 80 percent of HIV-infected Texas prison inmates did not fill an initial prescription for antiretroviral therapy within 30 days of their release from prison, potentially increasing their risk for harmful health consequences because of an interruption of treatment, according to a study in the February 25 issue of JAMA.
"The U.S. prison system has become an important front in the effort to treat and control the spread of human immunodeficiency virus (HIV) infection, serving as the principal screening and treatment venue for thousands of individuals with or at high risk for HIV infection who have limited access to community-based health care. Many inmates are offered HIV testing for the first time while incarcerated, and three-quarters of inmates with HIV infection initiate treatment during incarceration," the authors write.
Because the majority of former inmates are without private or public health insurance for the first several months after release, accessing antiretroviral therapy (ART) in a timely manner represents a challenge. "Those who discontinue ART at this time are at increased risk of developing a higher viral burden, resulting in greater infectiousness and higher levels of drug resistance, potentially creating reservoirs of drug-resistant HIV in the general community," they add. The extent to which HIV-infected inmates experience ART interruption following release from prison is unknown.
Jacques Baillargeon, Ph.D., of the University of Texas Medical Branch, Galveston, and colleagues conducted a study in the nation's largest state prison system to determine the proportion of HIV-infected inmates who filled a prescription for ART medication within 60 days following their release from prison. The study included all 2,115 HIV-infected inmates released from the Texas Department of Criminal Justice prison system between January 2004 and December 2007 who were receiving ART before release.
Among the entire study group, an initial prescription for ART medication was filled by 115 (5.4 percent) of the former inmates within 10 days of release, by 375 (17.7 percent) within 30 days, and by 634 (30.0 percent) within 60 days. The authors found that Hispanic and African American inmates were less likely to fill a prescription within 10 days and 30 days compared with non-Hispanic whites. Inmates with an undetectable viral load were more likely to fill a prescription than inmates with a detectable viral load at release. Inmates released on parole were more likely to fill a prescription within 30 days and 60 days than inmates with a standard, unsupervised release. Inmates who received formal assistance in completing an AIDS Drug Assistance Program application were more likely to fill a prescription than inmates who received no such assistance.
"In this 4-year study of HIV-infected inmates released from the nation's largest state prison system, we found that only 5 percent of released inmates filled a prescription for ART medications soon enough (i.e., within 10 days after release) to avoid treatment interruption," the authors write. In all of the subgroups examined, at least 90 percent of the former inmates experienced a treatment interruption; more than 70 percent had a treatment interruption that lasted at least 30 days, and more than 60 percent had a treatment interruption that lasted at least 60 days.
"These exceedingly high rates of treatment interruption suggest that most inmates face significant administrative, socioeconomic, or personal barriers to accessing ART when they return to their communities. Future prospective and in-depth qualitative studies are needed to more rigorously examine these barriers. Adequately addressing a public health crisis of this scale and complexity will require carefully coordinated efforts between academic institutions, the criminal justice system, and public health agencies," the researchers write. "In particular, greater coordination between state and local agencies, health care institutions, and community-based organizations is needed to reduce this high rate of treatment interruption among newly released inmates."
(JAMA. 2009;301[8]:848-857. 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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JAMA REPORTS
VIDEO:
Windows Media |
Quicktime
NEW STUDY SHOWS A NEARLY TWO-FOLD RISK OF PERINATAL DEPRESSION IN LOW-INCOME WOMEN WITH DIABETES
INTRO:
While depression affects a similar proportion of pregnant, postpartum and nonpregnant women, new onset depression is higher during the perinatal period - the last 2 trimesters of pregnancy and the year following. Now, a new study shows that having diabetes may make a woman more prone to the condition. Haley Weldon explains in this week's JAMA Report.
VIDEO:
B-ROLL
Taheera walking out of building, into car
AUDIO:
VO: (:05)
AFTER GIVING BIRTH TO HER SON, TAHEERA MASSEY WAS OVERWHELMED WITH POSTPARTUM DEPRESSION.
VIDEO:
SOT/FULL
Super @:06
Taheera Massey
Suffered from Postpartum depression
AUDIO:
Runs: :17
I would drive past, like cemeteries, like, this seems really grim, but I would and I would be, like, well maybe I was, I'm better there, where this would stop, like, my sadness and feeling like everybody was pulling at me and I didn't know who I was...
VIDEO:
SOT/FULL
Super @: 22
Katy Backes Kozhimannil, M.P.A.
Research Fellow and Ph.D. candidate
Harvard Medical School
AUDIO:
Runs: 19
It's an illness that affects up to 10-12% of new mothers but is not yet well understood and so any risk factors that we can help to understand, to help better identify women with postpartum depression will help contribute to better clinical care for these women.
VIDEO:
B-ROLL
Katy walking down hallway
Katy doing research
GFX/
U.S. map, NJ highlighted
Medicaid
11,024 women
Gave birth between:
7/01/04 – 9/30/06
AUDIO:
VO: (:23)
WITH THAT IN MIND, KATY BACKES KOZHIMANNIL OF HARVARD MEDICAL SCHOOL, AND HER COLLEAGUES DECIDED TO LOOK AT WHETHER DIABETES – WHICH HAS BEEN LINKED TO DEPRESSION IN GENERAL ADULT POPULATIONS – MIGHT ALSO BE A RISK FACTOR FOR DEPRESSION IN PREGNANT OR NEW MOTHERS. UTILIZING NEW JERSEY'S MEDICAID CLAIMS DATABASE, THEY ANALYZED THE RECORDS OF OVER 11,000 WOMEN WHO GAVE BIRTH BETWEEN JULY 2004 AND SEPTEMBER 2006.
VIDEO:
SOT/FULL
Katy Backes Kozhimannil, M.P.A.
Research Fellow and Ph.D. candidate
Harvard Medical School
AUDIO:
Runs: :22
In our study, 15.2 % of women with diabetes developed depression during pregnancy or the post partum year in contrast to that, 8.5 % of women without diabetes developed depression during this same time period. This represents a nearly 2-fold risk of developing depression during the perinatal period for women with diabetes.
VIDEO:
GFX/JAMA COVER
GFX/FULL PAGE
In Women With No Depression Diagnosis
Prior to Giving Birth
Those with diabetes: 9.6% developed
Postpartum depression
Those without diabetes: 5.9% developed
Postpartum depression
AUDIO:
VO: (:13)
THE STUDY, APPEARING THIS WEEK IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, ALSO FOUND THAT IN WOMEN WITH NO INDICATION OF DEPRESSION PRIOR TO GIVING BIRTH, AGAIN, THOSE WITH DIABETES HAD A GREATER CHANCE OF DEVELOPING DEPRESSION POSTPARTUM THAN THOSE WITHOUT.
VIDEO:
SOT/FULL
Katy Backes Kozhimannil, M.P.A.
Research Fellow and Ph.D. candidate
Harvard Medical School
AUDIO:
Runs: :10
We don't know for sure if diabetes causes depression or depression causes diabetes in this population; what we know is that there is an association.
VIDEO:
B-ROLL
Moms w/strollers
AUDIO:
VO: (:09)
RESEARCHERS HOPE LINKING THESE TWO ILLNESSES WILL MAKE IT EASIER TO IDENTIFY WOMEN AT RISK, AND GET THEM THE CARE THEY NEED. HALEY WELDON, THE JAMA REPORT.
