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May 12, 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
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, May 12, 2009)
JAMA REPORT (VIDEO SCRIPT)
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. TV Note: This week's JAMA Report video is on the effect of a diet and exercise intervention on functional outcomes for older, overweight, long-term cancer survivors. The report will be fed Tuesday, May 12, 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. 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), Tuesday, May 12, 2009
Diet and Exercise Intervention Helps Older, Overweight Cancer Survivors Reduce Functional Decline
CHICAGO—A home-based diet and exercise program reduced the rate of functional decline among older, overweight long-term survivors of colorectal, breast and prostate cancer, according to a study in the May 13 issue of JAMA. "In 2008, the Centers for Medicare & Medicaid Services declared mobility maintenance and functional independence among at-risk older individuals as the sole priority in aging research. Older cancer survivors represent an important target because cancer and its treatment are associated with accelerated functional decline," the authors write. The practice of healthy lifestyle behaviors may reduce risk for disease and functional decline. However, many older cancer survivors report poor lifestyle behaviors, and few meet recommended health promotion guidelines. "Lifestyle interventions may provide benefit, but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status." Miriam C. Morey, Ph.D., of Duke University, Durham, N.C., and colleagues conducted a randomized, controlled trial that tested a home-based diet and exercise intervention and its effect on functional decline among 641 older (age 65-91 years), overweight (BMI 25 or greater and less than 40) long-term (5 years or greater) survivors of breast, prostate, and colorectal cancer. The participants were randomly assigned to an intervention group (n = 319) or delayed intervention (control) group (n = 322) in Canada, the United Kingdom, and the United States. The 12-month intervention consisted of a home-based program of telephone counseling and mailed materials promoting exercise, improved diet quality, and modest weight loss. Change in functional status was assessed using the physical function subscale of the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire (score range, 0-100; a high score indicates better functioning). Other outcomes included changes in function on the basic and advanced lower-extremity function (i.e., use of legs) subscales of the Late Life Function and Disability Index (score range, 0-100), physical activity, body mass index and overall health-related quality of life. The average physical function score at the beginning of the study was 75.7, which is comparable with the median (midpoint) score for men and women age 65 years or older. For the SF-36 physical function subscale, the average function scores declined less rapidly in the intervention group (average score change of -2.15) than in the control group (average score change of -4.84). There was a statistically significant difference between study groups in basic lower-extremity function as function changed negligibly in the intervention group, whereas the control group showed a decrease in function. There were significant differences between the intervention and control groups for all targeted behaviors except endurance exercise frequency. Duration of strength training exercise and endurance exercise minutes increased in the intervention group and remained stable in the control group. The average intake of fruits and vegetables increased by 1.24 daily servings in the intervention group and by 0.13 daily servings in the control group. The average consumption of saturated fat decreased by 3.06 grams per day in the intervention group and by only 1.07 grams per day in the control group. Participants in the intervention group reported an average weight loss of 4.5 pounds, which was more than twice that reported by the control group (2.03 pounds). Overall health-related quality of life decreased in every subscale in the control group throughout the 12-month period. In the intervention group, decreases in subscale scores were of lower magnitude and were sustained for overall health and mental health.
"In conclusion, this study provides data on a long overlooked, yet important faction in older long-term cancer survivors. Long-term survivors of colorectal, breast, and prostate cancer participating in a diet and exercise intervention reduced the rate of self-reported physical function decline in comparison with a group receiving no intervention," the researchers write. "Future studies should not only assess the effect on health and well-being, but also should address cost-related outcomes, especially given that the economic burden associated with functional decline and loss of independence is exceedingly high."
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), Tuesday, May 12, 2009
Low and High Levels of Hormone in Men With Heart Failure Associated With Increased Risk of Death
CHICAGO—Men with systolic chronic heart failure who have low or high levels of estradiol, a form of the hormone estrogen, have an increased risk of death compared with men with moderate levels of this hormone, according to a study in the May 13 issue of JAMA. Estrogens have numerous biological effects in men and have a complex effect on the normal cardiovascular system, including cardioprotective effects, which may explain the link between low estradiol concentrations and an increased risk of cardiovascular events in men, according to background information in the article. Ewa A. Jankowska, M.D., Ph.D., of the Center for Heart Disease, Military Hospital, Wroclaw, Poland, and colleagues examined the relationship between estradiol concentrations in the blood and the rate of death in men with chronic heart failure (HF) and reduced left ventricular ejection fraction (LVEF; a measure of how well the left ventricle of the heart pumps with each contraction). The study, conducted at two cardiology centers in Poland, included 501 men (average age, 58 years). The patients were divided into 5 groups (quintiles), determined by the level of estradiol in their blood. Quintile 3 was considered the reference group. Among the patients, 171 deaths (34 percent) occurred during the 3-year follow-up. Analysis indicated that the most favorable outcome was in patients with estradiol levels within the middle quintile, whereas the highest 3-year mortality rates were observed in men in the lowest quintile (about 4 times higher risk of death) and those in the highest quintile (about twice the risk of death) of circulating estradiol levels. For increasing estradiol quintiles, 3-year survival rates adjusted for clinical variables and androgens (male sex hormones) were: 44.6 percent for quintile 1; 65.8 percent for quintile 2; 82.4 percent for quintile 3; 79.0 percent for quintile 4; and 63.6 percent for quintile 5.
"Both low and high concentrations of circulating estradiol are significant predictors of a poor prognosis, independently of gonadal [testis] and adrenal androgen deficiencies and conventional clinical prognostic indicators," the authors write. "Further studies are needed to explain the origin of these hormonal derangements."
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), Tuesday, May 12, 2009
Aspirin Appears To Be Associated With Lower Risk of Stroke For Patients With Peripheral Artery Disease
CHICAGO—An analysis of previous studies indicates that among patients with peripheral artery disease, aspirin use is associated with a statistically nonsignificant decrease in the risk of a group of combined cardiovascular events (nonfatal heart attack, nonfatal stroke, and cardiovascular death), but is associated with a significant reduction in the risk of one of these events, nonfatal stroke, although the findings may be limited by the lack of a large study population, according to an article in the May 13 issue of JAMA. Although aspirin is effective in the prevention of cardiovascular events in patients with symptomatic coronary heart disease and cerebrovascular disease, its effect in patients with peripheral artery disease (PAD) has been uncertain, according to background information in the article. Despite limited supporting data, some current guidelines recommend aspirin use for patients with PAD (partial or total blockage of an artery, usually one leading to a leg or arm, with symptoms including fatigue, cramping and pain from walking; and when the arm is in motion, discomfort, heaviness, tiredness and cramping). To assess the effect of aspirin on cardiovascular event rates in patients with PAD, Jeffrey S. Berger, M.D., M.S., of the University of Pennsylvania, Philadelphia, and colleagues conducted a meta-analysis to evaluate available evidence from randomized controlled trials of aspirin therapy, with or without dipyridamole (an antiplatelet agent), that reported cardiovascular event rates (the primary events for this analysis were nonfatal myocardial infarction [MI; heart attack], nonfatal stroke, and cardiovascular death). The researchers identified 18 trials, which included 5,269 patients, of whom 2,823 were randomized to aspirin therapy (of these, 1,516 received aspirin monotherapy) and 2,446 were randomized to placebo or control. The researchers found that a total of 251 (8.9 percent) cardiovascular events occurred among the patients receiving any aspirin therapy compared with 269 (11.0 percent) events among the control patients, a 12 percent reduction in cardiovascular event rates, which was not statistically significant. Results for associations of aspirin therapy with the individual components of the primary events indicated that the risk of nonfatal stroke was significantly lower (34 percent) in the aspirin group than in the placebo (a rate of events of 1.8 percent vs. 3.1 percent), but was not associated with significant reductions in all-cause or cardiovascular death, heart attack, or major bleeding. A total of 125 cardiovascular events occurred among 1,516 patients (8.2 percent) receiving aspirin monotherapy compared with 144 events among 1,503 patients (9.6 percent) in the placebo or control groups. Aspirin monotherapy was associated with a 36 percent reduction in the risk of nonfatal stroke (2.1 percent vs. 3.4 percent), but no statistically significant reductions in all-cause or cardiovascular death, heart attack, or major bleeding. "Results of this meta-analysis demonstrated that for patients with PAD, aspirin therapy alone or in combination with dipyridamole did not significantly decrease the primary end point of cardiovascular events, results that may reflect limited statistical power," the authors write. "The major limitations of this meta-analysis reflect the limitations of published literature on aspirin for treating PAD. Many of these trials were small and of short duration, resulting in few major cardiovascular events."
"However the current evidence was insufficient to rule out small yet important benefits of aspirin (as suggested by the point estimate of a 12 percent risk reduction)," they add. "Larger prospective studies of aspirin and other antiplatelet agents are warranted among patients with PAD in order to draw firm conclusions about clinical benefit and risks."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: Aspirin and Secondary Prevention in Peripheral Artery Disease — A Perspective for the Early 21st Century
Mary McGrae McDermott, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, and a contributing editor of JAMA, and Michael H. Criqui, M.D., M.P.H., of the University of California, San Diego School of Medicine, write that more research is needed regarding the outcomes of aspirin use by patients with PAD.
"The meta-analysis by Berger et al enriches current understanding of the association of aspirin with cardiovascular outcomes in patients with PAD. However, based on the limitations of data available, the findings should not alter recommendations for aspirin as an important therapeutic tool for secondary prevention in patients with PAD. To best inform evidence-based clinical practice guidelines, more high-quality clinical trials are needed. Achieving this will require greater resources for research and a larger critical mass of clinical investigators dedicated to the study of PAD."
Editor's Note: Please see the article for additional information, including 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), Tuesday, May 12, 2009
Policies on Organ Donation After Cardiac Death Vary Considerably Among Children's Hospitals
CHICAGO—Although a large number of children's hospitals have developed or are developing policies regarding organ donation after cardiac death, there is considerable variation among policies, including the criteria for declaring death, according to a study in the May 13 issue of JAMA. Donation after cardiac death (DCD) potentially permits patients who do not meet the neurological criteria for death to donate solid organs. "Controlled DCD occurs following planned withdrawal of life-sustaining treatment, and uncontrolled DCD occurs after unanticipated cardiac arrest. Potential controlled DCD donors include patients with irreversible catastrophic brain injury or end-stage neuromuscular diseases," the authors write. Although the Joint Commission requires all hospitals to address DCD, little is known about actual hospital policies. Armand H. Matheny Antommaria, M.D., Ph.D., of the University of Utah School of Medicine, Salt Lake City, and colleagues conducted a study to evaluate the development and content of DCD policies at children's hospitals and evaluate variation among policies, which were collected between November 2007 and January 2008 from hospitals in the United States, Puerto Rico, and Canada. Of inquiries to 124 children's hospitals, a response was received from 105 (85 percent). Of these respondents, 72 percent had DCD policies, 19 percent were developing policies, and 7 percent neither had nor were developing policies. The researchers received and analyzed 73 approved policies. Sixty-one (84 percent) specify criteria or tests for declaring death, including electrocardiogram (ECG) findings, pulselessness, apnea, and unresponsiveness. Four policies require total waiting periods prior to organ recovery at variance with professional guidelines: 1 less than 2 minutes and 3 longer than 5 minutes. Sixty-four policies (88 percent) preclude transplant personnel from declaring death and 51 percent prohibit them from involvement in premortem (taking place immediately before death) management. While 65 policies (89 percent) indicate the importance of palliative care, only 7 percent recommend or require palliative care consultation. Thirty-two policies (44 percent) preclude the use of medications with the intention to hasten death. Policies differ in the location of withdrawal of life-sustaining treatment. Sixty-eight policies (93 percent) specify the location, with the majority (54 percent) requiring withdrawal of treatment to occur in the operating room. Other potential locations include areas adjacent to the operating room (19 percent), the emergency department (4 percent), or the intensive care unit (4 percent). "This study demonstrates that, consistent with a national emphasis on increasing the supply of transplantable organs, a large number of children's hospitals have developed or are developing DCD policies," the authors write.
"The policies exhibit notable variation both within those we studied and compared with authoritative reports and statements. Further research will be required to determine the importance of variation in the tests for declaring death or the processes for withdrawing life-sustaining treatment. In the long run, public policy may need to address strategies to promote adherence to recommendations for DCD processes based on sufficient clinical evidence and/or ethical justification."
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.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
HOME-BASED DIET AND EXERCISE INTERVENTION HELPS PREVENT FUNCTIONAL DECLINES IN LONG-TERM CANCER SURVIVORS
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