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May 26, 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 26, 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. SAVE THE DATE: JAMA will present new research from a theme issue on Child Health at a media briefing on Tuesday, June 2, from 10 a.m. – 12:15 p.m., at the Hilton New York, 1335 Avenue of the Americas. To register, go to www.jamamedia.org and click on the Events tab, or call 312-464-JAMA. Program information will be included in a future email. TV Note: This week's JAMA Report video is on the prevalence of cardiovascular disease risk factors among National Football League players. The report will be fed Tuesday, May 26, 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 26, 2009
Intervention Helps Reduce Pain and Depression
CHICAGO—For patients who experience pain and depression, common co-existing conditions, an intervention that included individually tailored antidepressant therapy and a pain self-management program resulted in greater improvement in the symptoms of these conditions than patients who received usual care, according to a study in the May 27 issue of JAMA. Pain complaints account for more than 40 percent of all symptom-related outpatient visits, and depression is present in 10 percent to 15 percent of all patients who receive primary care. Pain and depression frequently co-exist (30 percent-50 percent co-occurrence), effect the treatment responsiveness of each, and have adverse effects on quality of life, disability, and health care costs, according to background information in the article. Kurt Kroenke, M.D., of Indiana University School of Medicine, Indianapolis, and colleagues conducted a study to determine if a combined pharmacological and behavioral intervention improves both depression and pain in primary care patients with musculoskeletal pain and co-existing depression. The trial (Stepped Care for Affective Disorders and Musculoskeletal Pain [SCAMP]) included 250 patients who had low back, hip, or knee pain for 3 months or longer and at least moderate depression severity. Patients were randomly assigned to the intervention (n = 123) or to usual care (n = 127). Depression was assessed with the 20-item Hopkins Symptom Checklist, and pain primarily with the Brief Pain Inventory. The intervention consisted of 12 weeks of optimized antidepressant therapy (actively managed by a nurse care manager); followed by 6 sessions of a pain self-management program over 12 weeks (during each session, the nurse care manager introduces new strategies for patient self-management, assists the patient in choosing strategies, and supervises the patient as he/she practices the chosen strategy); and a 6-month continuation phase, in which symptoms were monitored and treatments reinforced, with a focus on preventing relapse. The researchers found that the intervention group had significantly better outcomes for depression. The intervention group was more than twice as likely to experience depression response (46 of 123 intervention patients [37.4 percent] vs. 21 of 127 usual care patients [16.5 percent]) and nearly 4 times as likely to experience complete remission (17.9 percent vs. 4.7 percent) at 12 months, corresponding to a much lower number of patients with major depression (40.7 percent vs. 68.5 percent). Intervention patients were also much more likely than usual care patients to report overall improvement in their pain at 12 months (47.2 percent vs. 12.6 percent). In terms of the trial's primary outcome, the intervention group was significantly more likely to experience a composite response, defined as a reduction of 50 percent or greater in depression and a reduction of 30 percent or greater in pain. This difference in composite response rates was significant at both 6 months (23.6 percent for intervention patients vs. 7.9 percent for usual care patients) and 12 months (26.0 percent vs. 7.9 percent). "It is possible that pain improvement in our trial reflected a main effect of improved mood (i.e., an antidepressant effect on mood rather than an analgesic effect), and that as depression lifts, patients may experience pain as being less intense and less disabling. Conversely, it is also possible that the improvement in depression was mediated by an improvement in pain (i.e., as pain improves, patients feel less depressed) or that both depression and pain lessened as a result of treatment effects on a common pathway," the authors write.
"Because pain and depression are among the leading causes of decreased work productivity, an intervention that is effective for both conditions may further strengthen a business model. Also, an intervention that allows a care manager to cover several conditions rather than a single disorder may enhance its implementation and cost-effectiveness. Given the prevalence, morbidity, disability, and costs of the pain-depression dyad, the SCAMP trial results have important implications."
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 26, 2009
NFL Players Have More Favorable Glucose Levels, Similar Cholesterol Levels, Higher Rate of High Blood Pressure Compared to Other Healthy Young Men
CHICAGO—Despite being larger in size and heavier in weight, an analysis of the cardiovascular disease risk factors of about 500 National Football League players finds that they have a lower incidence of impaired fasting glucose and similar prevalence of abnormal cholesterol and triglyceride levels as compared to a sample of healthy young-adult men, but have an increased prevalence of high blood pressure, according to a study in the May 27 issue of JAMA. Concern exists about the cardiovascular health implications of large size among professional football players and those players who aspire to professional status. A significant increase in body mass index (BMI) for offensive and defensive linemen has been noted during the past 30 years, and BMI fitting the category of class II obesity was reported in more than a quarter of National Football League (NFL) players in 2003, according to background information in the article. Greater player size and sporadic deaths of active and young retired professional football players have raised questions about an associated increase in cardiovascular disease (CVD) risk. Andrew M. Tucker, M.D., of Union Memorial Hospital, Baltimore, and colleagues conducted a study to compare the prevalence of CVD risk factors in NFL players with men of the same age in the general U.S. population. The study included 504 active, veteran football players from a sample of 12 NFL teams. Data collected during team mini-camps between April and July 2007 included health histories; height; weight; neck, waist, and hip circumferences; body composition; fasting glucose; total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides; blood pressure; pulse; and electrocardiograms. Data were compared with men of the same age in the general U.S. population who were participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study, which included 1,959 participants age 23 to 35 years. The NFL players were taller and heavier than the CARDIA group. The researchers found that despite their larger size, the NFL group had lower average fasting glucose levels and a significantly lower prevalence of impaired fasting glucose (6.7 percent vs. 15.5 percent) compared with the CARDIA group. Between the two groups, there were no significant differences in the prevalence of high total cholesterol, high LDL-C, low HDL-C or high triglycerides. Also, the NFL players were less likely to smoke when compared with the CARDIA group (0.1 percent vs. 30.5 percent). The NFL players did have a significantly higher prevalence of hypertension (13.8 percent vs. 5.5 percent) and prehypertension (64.5 percent vs. 24.2 percent) compared with the CARDIA group. Of the 504 NFL players, seven were taking antihypertensive medication currently or in the past month, three of whom were identified as having hypertension only by their medication use.
"This unexpected prevalence of prehypertension and hypertension has led to plans for an NFL-wide survey and in-depth investigation of the mechanisms of these findings. Proposed areas for investigation include strength and resistance training, long-term use of nonsteroidal anti-inflammatory drugs, salt intake, and sleep disordered breathing," the authors write. They suggest the high levels of physical activity in the NFL sample is probably important in lessening the effect of large size on some of the measured cardiovascular risk factors.
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 26, 2009
Use of Acid-Suppressive Medications Associated With Increased Risk of Hospital-Acquired Pneumonia
CHICAGO—Hospitalized patients who receive acid-suppressive medications such as a proton-pump inhibitor have a 30 percent increased odds of developing pneumonia while in the hospital, according to a study in the May 27 issue of JAMA. With the introduction of proton-pump inhibitors, used primarily in the treatment of ulcers and gastroesophageal reflux disease, the use of acid-suppressive medications has increased significantly over the last several years, with estimates that between 40 percent and 70 percent of hospitalized patients receive some form of them. But this high use in the inpatient setting has been of concern for several reasons, including use for indications that are not supported by research and data suggesting an increased risk for community-acquired pneumonia with use in outpatient settings, according to background information in the article. Shoshana J. Herzig, M.D., of Beth Israel Deaconess Medical Center, Boston, and colleagues examined the association between acid-suppressive medication use and hospital-acquired pneumonia. The study included data on patients who were admitted to a large, urban, academic medical center from January 2004 through December 2007, including patients who were at least 18 years of age, hospitalized for 3 or more days, and not admitted to the intensive care unit. Acid-suppressive medication use was defined as any order for a proton-pump inhibitor or histamine2 receptor antagonist. The study included data on 63,878 hospital admissions. Overall, acid-suppressive medication was ordered in 32,922 admissions (52 percent). Of the group who received these medications, 27,236 (83 percent) received proton-pump inhibitors and 7,548 (23 percent) received histamine2 receptor antagonists, with some exposed to both. The majority of these medications were ordered within 48 hours of admission (89 percent). Hospital-acquired pneumonia occurred in 2,219 admissions (3.5 percent). The unadjusted incidence of hospital-acquired pneumonia was higher in the group exposed to acid-suppressive medication relative to the unexposed group (4.9 percent vs. 2.0 percent). After further analysis and adjusting for potential factors that could influence the outcomes, receiving acid-suppressive medications was associated with a 30 percent increased odds of hospital-acquired pneumonia. The association was significant for proton-pump inhibitors but not for histamine2 receptor antagonists. The researchers write that acid-suppressive medications have been thought to increase the risk of pneumonia via modification of upper gastrointestinal bacteria, and, as a result, respiratory bacteria.
"These results occur in the context of an increasing body of literature suggesting an association between acid-suppressive medication and pneumonia. Further scrutiny is warranted regarding inpatient prescribing practices of these medications," the authors conclude.
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
HIGH FITNESS LEVEL MAY OFFSET THE IMPACT OF LARGE SIZE ON NFL PLAYERS' HEART DISEASE RISK
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