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July 5, 2010 — Embargoed ContentJAMA 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. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE NEWS RELEASES
Complete Table of Contents
(Embargoed Until: 3 P.M. (CT), Monday, July 5, 2010)
ARCHIVES OF GENERAL PSYCHIATRY NEWS RELEASES
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(Embargoed Until: 3 P.M. (CT), Monday, July 5, 2010)
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, July 5, 2010
Delayed School Start Time Associated With Improvements in Adolescent Behaviors
CHICAGO—A short delay in school start time appears to be associated with significant improvements in adolescent alertness, mood and health, according to a report in the July issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. "Beginning at the onset of puberty, adolescents develop as much as a two-hour sleep-wake phase delay (later sleep onset and wake times) relative to sleep-wake cycles in middle childhood," the authors write as background to the study. The study also notes that, "adolescent sleep needs do not decrease dramatically, and optimal sleep amounts remain about nine to 9 1/4 hours per night." Judith A. Owens, M.D., M.P.H., of the Hasbro Children's Hospital, Providence, and colleagues, studied 201 students in grades 9 through 12 attending an independent high school in Rhode Island. For the purposes of the study, class start time was delayed 30 minutes, from 8 a.m. to 8:30 a.m. Additionally, students were required to complete the online retrospective Sleep Habits Survey before and after the change in school start time. According to the study, after the delayed start time, "students reported significantly more satisfaction with sleep and experienced improved motivation. Daytime sleepiness, fatigue and depressed mood were all reduced. Most health-related variables, including Health Center visits for fatigue-related complaints, and class attendance also improved." The later start was also associated with a significant increase in sleep duration on school nights of 45 minutes as well as a reduction in weekend oversleep (the difference between school day and non-school day wake times). The percentage of students getting less than seven hours of sleep decreased by 79.4 percent, and those reporting at least eight hours of sleep increased from 16.4 percent to 54.7 percent. Additionally, the percentage of students rating themselves as at least somewhat unhappy or depressed decreased significantly (from 65.8 percent to 45.1 percent), as well as the percentage who felt annoyed or irritated throughout the day (from 84 percent to 62.6 percent). In terms of health consequences, significantly more students self-reported visiting the Health Center for fatigue-related symptoms before the delayed start time (15.3 percent versus 4.6 percent).
The study also found that after the delayed start, "students rated themselves as less depressed and more motivated to participate in a variety of activities and were less likely to seek medical attention for fatigue-related concerns in conjunction with the change in start times." Additionally, "despite the initial considerable resistance voiced by the faculty and athletic coaches to instituting the start time delay and the original intentions of the school administration to return to the 8 a.m. start time after the trial period, students and faculty overwhelmingly voted to retain the 8:30 a.m. start for the spring term."
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc. Editorial: School Start Time and Sleepy Teens
"Given that Owens et al report similar findings to the earliest research, there is a growing body of evidence that changing start time for high schools is good for adolescents. So, the follow-up question is: 'Why aren't more schools changing to a later time?'" writes Kyla Wahlstrom, Ph.D., of the University of Minnesota, St. Paul, in an accompanying editorial. "The answer to that is actually very complicated...The time that a school starts is felt to be sacrosanct by those who have come to rely on it as a predictable part of their day and life." "The role of data and factual information in discussing and advocating for changing school start times is key...when the first findings emerged in 1997, the question remaining at that time concerned the effect of the later start time on academic outcomes. Longitudinal research has since found several significant academic effects, such as decreasing the dropout rate, but a direct correlation between later start time and academic achievement on normed tests has not been substantiated."
"In the end, having comprehensive information and impartial presentation of what is known, and not assumed, is needed to really begin the local dialogue," Dr. Wahlstrom concludes. The community at large is, after all, the final arbiter, as all must truly live with the consequences. Our teenagers need and deserve our best informed thinking about all of this; having the facts in hand is the best place to start."
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, July 5, 2010
Kids Now See Fewer Television Ads for Sweets and Beverages, But More for Fast Food
CHICAGO—Children saw fewer television advertisements for certain foods, including those for sweets and beverages, in 2007 compared with 2003, according to a report posted online today that will appear in the September print issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals. However, children now see more fast-food ads, and racial gaps in exposure to all food advertising have increased. An Institute of Medicine (IOM) report concluded that there was strong evidence that television advertising influences the short-term eating habits of children age 2 to 11, and moderate evidence that advertising influences their usual dietary intake, according to background information in the article. In 2006, 10 major U.S. food companies pledged to devote at least half of their child-targeted advertising to healthier products or encouraging good nutrition and healthy lifestyles, an effort called the Children's Food and Beverage Advertising Initiative. By 2009, 16 companies had signed on. "Given that each company defined their own better-for-you products and also had different definitions of what constituted children's programming, key questions remain," the authors write. To assess trends in food advertising before and after the initiative, Lisa M. Powell, Ph.D., and colleagues at the University of Illinois at Chicago studied television ratings data from Nielsen Media Research for the calendar years 2003, 2005 and 2007. Between 2003 and 2007, daily average exposure to televised food ads decreased by 13.7 percent among children age 2 to 5 and 3.7 percent among children age 6 to 11, but increased by 3.7 percent among teens age 12 to 17. Ads for sweets became less frequent, with a 41 percent decrease in exposure for 2- to 5-year-olds, 29.3 percent for 6- to 11-year-olds and 12.1 percent for 12- to 17-year-olds. Beverage ads also decreased in frequency, by about 27 percent to 30 percent across age groups, with substantial decreases in exposure to ads for previously heavily advertised sugar-sweetened beverages. However, exposure to fast-food ads increased between 2003 and 2007, with a 4.7 percent increase in viewings among children age 2 to 5, 12.2 percent among children 6 to 11 and 20.4 percent among teens age 12 to 17. The high prevalence of these ads suggests the importance of branding, the authors note. "Indeed, children have been found to recognize brand logos at very young ages and a recent study found that preschoolers exhibited significantly higher preferences for food and beverage items in branded vs. plain packaging," they write. The racial gap in advertising also increased in this time period. By 2007, African American children saw 1.4 to 1.6 times as many food ads per day than white children, depending on their age. "In particular, African American children and teens had more than double the rate of increase in exposure to fast food ads compared with their white counterparts," the authors write.
"A number of positive changes have occurred in children's exposure to food advertising," they conclude. "Continued monitoring of children's television food ad exposure along with nutritional assessments of advertised products will improve understanding of the extent to which self-regulation can translate into a reduction in the promotion of unhealthy food products."
Editor's Note: The authors gratefully acknowledge research support from the Robert Wood Johnson Foundation through the Bridging the Gap program for the ImpacTeen project. 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, July 5, 2010
Plasma Protein Appears to Be Associated With Development and Severity of Alzheimer's Disease
CHICAGO—Higher concentrations of clusterin, a protein in the blood plasma, appears to be associated with the development, severity and progression of Alzheimer's disease, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Individuals with Alzheimer's disease display several findings in their blood and cerebrospinal fluid that may reflect neuropathological changes, according to background information in the article. For instance, in cerebrospinal fluid, individuals with Alzheimer's disease have lower levels of amyloid-beta peptides and higher levels of total and phosphorylated tau concentration, which reflect the formation of hallmark plaques and tangles in the brain. Similarly, numerous articles have suggested that levels of certain metabolites and proteins in the plasma might represent responses to brain changes in Alzheimer's disease, but none have been replicated. Madhav Thambisetty, M.D., Ph.D., of Institute of Psychiatry, King's College London, and colleagues used a combined proteomic and neuro-imaging approach to identify plasma proteins associated with Alzheimer's disease pathology. Participants in two studies—some with Alzheimer's disease, some with its precursor mild cognitive impairment and some with no dementia—underwent standardized clinical assessments and brain imaging scans. Their blood plasma was then assessed for proteins that may be associated with Alzheimer's disease. Based on findings of two "discovery phase" studies in 95 patients, one protein, clusterin, appeared to be associated with atrophy of the hippocampal region of the brain and with rapid progression of cognitive decline. The researchers then studied clusterin levels in all 689 participants (including 464 with Alzheimer's disease) and found an association between higher plasma levels of the protein and severity of disease, rapid clinical progression and atrophy in the brain area known as the entorhinal cortex, which plays a role in memory. In addition, increased clusterin levels in the plasma were associated with having more amyloid-beta—which forms the brain plaques associated with Alzheimer's disease—in the brain's medial temporal lobe. According to the authors, "previous studies suggest that clusterin belongs to a family of extracellular chaperones," proteins that regulate the formation and removal of amyloid. "Although these findings do not support the clinical utility of plasma clusterin concentration as a stand-alone biomarker for Alzheimer's disease, they reveal a robust peripheral signature of this amyloid chaperone protein that is responsive to key features of disease pathology."
"Our findings clearly implicate clusterin, but there may well be other proteins in plasma related to the disease process, and indeed our previous studies and those of others suggest this is the case," they conclude. "These results may have wider implications for the identification of other amyloid chaperone proteins in plasma, both as putative Alzheimer's disease biomarkers as well as drug targets of disease-modifying treatments."
Editor's Note: Intellectual property has been registered on the use of plasma proteins, including clusterin, for use as biomarkers for Alzheimer's disease by King's College London and Proteome Sciences, with Drs. Lovestone and Thambisetty and others named as inventors. Co-author Dr. Wong has grant support and/or contracts from the National Institutes of Health, Acadia, Avid, Bristol-Myers Squibb, GE, Intracellular, Johnson & Johnson, Eli Lilly, Merck, Orexigen, Otsuka, Roche and Sanofi-Aventis. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, July 5, 2010
Heart Patients With Anxiety Disorder Experience More Cardiovascular Events, Deaths
CHICAGO—Among patients with heart disease, anxiety disorders appear to be associated with a higher risk of stroke, heart attack, heart failure and death, according to a report in the July issue of Archives of General Psychiatry, one of the JAMA/Archives journals. As many as 24 percent to 31 percent of patients with heart disease also have symptoms of anxiety, according to background information in the article. "Compared with the extensive literature on depression in patients with coronary heart disease, relatively few studies have examined the role of anxiety," the authors write. "Several studies have found that anxiety symptoms are predictive of disability, increased physical symptoms and worse functional status and quality of life in patients with coronary heart disease. However, studies examining anxiety as a risk factor for future coronary heart disease have yielded conflicting results." Elisabeth J. Martens, Ph.D., of Tilburg University, Tilburg, the Netherlands, and colleagues assessed 1,015 outpatients with stable coronary heart disease. The baseline examination consisted of interviews, blood and urine sample testing, exercise testing and electrocardiography. The presence of generalized anxiety disorder and of depressive disorder was determined using the computerized version of the Diagnostic Interview Schedule. After an average follow-up time of 5.6 years, a total of 371 cardiovascular events occurred. After adjusting for age, the yearly rate of cardiovascular events was 9.6 percent in the 106 participants with general anxiety disorder and 6.6 percent in the 909 participants without. After further adjustments for potentially confounding variables—including sex, co-occurring conditions, heart disease severity and medication use—generalized anxiety disorder was associated with a 74 percent increased risk of cardiovascular events. "This leaves the question of why generalized anxiety disorder is associated with adverse outcomes in patients with coronary heart disease," the authors write. Anxiety may be associated with surges in catecholamines, "fight or flight" hormones that may be related to heart risks, they suggest. Alternatively, patients with anxiety may be more likely to seek care when they have symptoms and therefore be more likely to receive a diagnosis of stroke or heart attack, although this would not explain the increased risk of death. It is also possible that a common underlying factor predisposes individuals to both anxiety and heart events.
"These findings have implications for clinical practice and research," they conclude. "Generalized anxiety disorder may be considered a prognostic factor in patients with coronary heart disease and could be used in risk stratification. Evaluation and treatment of anxiety may also be considered as part of the comprehensive management of patients with coronary heart disease. Research programs designed to advance our understanding of the impact of generalized anxiety disorders on medical prognosis and biobehavioral mechanisms that link anxiety to mortality in the context of coronary heart disease are needed to develop evidence-based approaches to improving patient care."
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, July 5, 2010
Abused Children Appear Likely to Have Mental Disorders as Young Adults
CHICAGO—Abuse and neglect during childhood appear to be associated with increased rates of mood, anxiety and substance use disorders among young adults, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Most studies of child maltreatment and later mental health outcomes have relied on reports of past abuse, according to background information in the article. Doubts have been raised about the reliability and validity of these reports, given that past maltreatment is often unreported, memories can be reconstructed and the reports can be unstable over time. Kate M. Scott, Ph.D., M.A. Appl.(Clin Psych), and colleagues at University of Otago—Wellington, Wellington, New Zealand, linked national child protection agency records with data from a nationally representative community survey of mental disorders among young adults age 16 to 27. The survey included 2,144 young adults, 221 of whom had a history of child maltreatment as indicated by child protection agency records. After adjusting for demographic and socioeconomic factors, a history of abuse or neglect was associated with having any mental disorder and with five individual mental disorders—including anxiety, mood and substance abuse conditions—both over a lifetime and in the previous year. The strongest associations were with post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder. When asked in young adulthood, 15 percent of the participants in the group without a child protection agency record reported maltreatment. "After excluding these individuals from the comparison group, the magnitude of associations increased, with child protection agency history conferring a 10-fold higher odds of 12-month PTSD, together with elevated odds of other anxiety disorders, mood disorders and drug use disorders," the authors write.
The findings suggest that maltreatment, not just the memory of maltreatment, is associated with mental health disorders in young adulthood. "This implies, first, that targeted mental health interventions with present or past clients of child welfare agencies are indicated in addition to the interventions currently provided to stop or reduce the maltreatment; and second, that concerted population-level strategies are required to address the needs of the many other children who also experience maltreatment."
Editor's Note: Rau Hinengaro: The New Zealand Mental Health Survey was funded by the Ministry of Health, the Alcohol Advisory Council of New Zealand and the Health Research Council of New Zealand. Part of the analysis for this article was supported by Otago University research funding. 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, July 5, 2010
Adolescent Cyberbullies and Their Victims May Have Physical, Mental Health Problems
CHICAGO—Adolescent victims and perpetrators of electronic bullying appear more likely to report having psychiatric and physical symptoms and problems, according to a report in the June issue of Archives of General Psychiatry, one of the JAMA/Archives journals. Cyberbullying is defined as an aggressive, intentional, repeated act using mobile phones, computers or other electronic forms of contact against victims who cannot easily defend themselves, according to background information in the article. In a U.S. survey on Internet use among individuals age 10 to 17 years, 12 percent reported being aggressive to someone online, 4 percent were targets of aggression and 3 percent were both aggressors and targets. "There are several special features regarding cyberbullying when compared with traditional physical, verbal or indirect bullying such as the difficulty of escaping from it, the breadth of the potential audience and the anonymity of the perpetrator," the authors write. Andre Sourander, M.D., Ph.D., of Turku University, Turku, Finland, and colleagues distributed questionnaires to 2,438 Finnish adolescents in seventh and ninth grade (age range, 13 years to 16 years). Of those, 2,215 (90.9 percent) were returned with sufficient information for analysis. In addition to information about cyberbullying and cybervictimization, the teens were asked to report their demographic information, general health, substance use, traditional bullying behavior and psychosomatic symptoms, such as headache and abdominal pain. In the six months prior to the survey, 4.8 percent of the participants were only victims of cyberbullying, 7.4 percent were cyberbullies only and 5.4 percent were both victims and perpetrators of cyberbullying. Being a cybervictim only was associated with living in a family with other than two biological parents; perceived difficulties in emotions, concentration, behavior, or getting along with other people; headache; recurrent abdominal pain; sleeping difficulties and not feeling safe at school. Being a cyberbully only was associated with perceived difficulties in emotions, concentration, behavior, or getting along with other people; hyperactivity; conduct problems; infrequent helping behaviors; frequently smoking or getting drunk; headache and not feeling safe at school. Being both cyberbully and cybervictim was associated with all of these conditions. "Of those who had been victimized, one in four reported that it had resulted in fear for their safety," the authors write. "The feeling of being unsafe is probably worse in cyberbullying compared with traditional bullying. Traditional bullying typically occurs on school grounds, so victims are safe at least within their homes. With cyberbullying, victims are accessible 24 hours a day, seven days a week."
The results suggest that cyberbullying is an increasingly important type of harmful behavior, the authors note. "There is a need to create cyberenvironments and supervision that provide clear and consistent norms for healthy cyberbehavior. Clinicians working in child and adolescent health services should be aware that cyberbullying is potentially traumatizing," they conclude. "Policy makers, educators, parents and adolescents themselves should be aware of the potentially harmful effects of cyberbullying."
Editor's Note: This study was supported by a grant from the Pediatric Research Foundation, Finland, and by the Finnish-Swedish Medical Association. 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. |
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