Delaying Start of Head, Neck Cancer Treatment in Underserved, Urban Patients Associated With Worse Outcomes

Posted September 10, 2019 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, SEPTEMBER 12, 2019

Media advisory: To contact corresponding author Vikas Mehta, M.D., M.P.H., email Tracy Gurrisi at tgurrisi@montefiore.org. The full study and commentary are linked to this news release.

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Bottom Line: This observational study looked at the factors and outcomes associated with delaying the start of treatment for head and neck squamous cell carcinoma (HNSCC) in an underserved urban population. The analysis included 956 patients with HNSCC treated at a health center in New York City. The authors report that delaying the initiation of treatment beyond 60 days was associated with poorer survival and an increased risk of HNSCC recurrence. Factors associated with delaying treatment included African American race/ethnicity, Medicaid insurance, being underweight and having an initial diagnosis at a different institution. Common reasons for delaying treatment were missed appointments leading up to the initial treatment and extensive pretreatment evaluation. Knowing predictive factors and reasons for delaying treatment can help identify at-risk patients and areas to reduce delay. Limitations of the study include the possibility of miscoding errors with the use of cancer registry and patient medical records.

Authors: Vikas Mehta, M.D., M.P.H., Montefiore Health System, Bronx, New York, and coauthors

(doi:10.1001/jamaoto.2019.2414)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Does Association of Frailty, Increased Risk of Death Waiting for Liver Transplant Differ by BMI?

Posted September 6, 2019 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 11, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This observational study examined among liver transplant candidates whether the association of frailty and increased risk of death while on the waiting list for a transplant varied by body mass index.

Authors: Jennifer C. Lai, M.D., M.B.A., of the University of California San Francisco, is the corresponding author.

(doi:10.1001/jamasurg.2019.2845)

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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Study Examines FDA Drug, Device Approvals Based on Nonrandomized Clinical Trials

Posted September 9, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 11, 2019

Media advisory: To contact corresponding author Benjamin Djulbegovic, M.D., Ph.D., email Letisia Marquez at lemarquez@coh.org. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: How often the U.S. Food and Drug Administration (FDA) has approved drugs and devices based on nonrandomized clinical trials (non-RCTs) and whether those approvals are associated with the sizes of treatment effects were the focus of this study. Applications for 606 drugs from 2012 to August 2018 and for 71 medical devices from 1996 to August 2017 were assessed, and approved applications based on non-RCTs were included in this study called a systematic review and meta-analysis. Of the 677 applications, 68 (10%) were approved by the FDA based on non-RCTs. A meta-analysis was conducted to examine differences between applications that required further testing with RCTs and those that didn’t. The authors report estimated treatment effects were higher for treatments or devices approved based on non-RCTs than for treatments or devices for which further testing in RCTs was required. There was no clear threshold of treatment effect above which no RCTs were requested. A limitation of the study was the small sample size.

Authors: Benjamin Djulbegovic, M.D., Ph.D., City of Hope, Duarte, California, and coauthors

(doi:10.1001/jamanetworkopen.2019.11111)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Gender Identity Conversion Efforts Associated With Adverse Mental Health Outcomes

Posted September 9, 2019 by Deanna Bellandi

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 11, 2019

Media advisory: To contact corresponding author Jack L. Turban, M.D., M.H.S., email Noah Brown at nbrown9@partners.org. The full study is linked to this news release.

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Bottom Line: Gender identity conversion efforts to try to change a person’s gender identity to match their sex assigned at birth were associated with increased likelihood of adverse mental health outcomes, including suicide attempts, in this study of nearly 28,000 transgender adults from across the United States. Professional organizations, including the American Psychiatric Association, have called conversion therapy for gender identity unethical and ineffective, and some states have outlawed the practice. This observational study is based on the results of a survey distributed through community outreach to transgender adults in all 50 states, the District of Columbia, some territories and overseas U.S. military bases. Of 27,715 transgender adults who responded, 19,741 (71.3%) reported having spoken to a secular or religious professional about their gender identity and of these 3,869 (19.6%) reported exposure to gender identity conversion efforts. That exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but weren’t exposed to conversion efforts. Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts. Limitations of the study include its inability to determine causation; it didn’t capture conversion efforts by others such as family members; and it’s possible that some adults with worse mental health might have sought conversion therapy. The study findings support that gender identity conversion efforts should be avoided in children and adults.

Authors: Jack L. Turban, M.D., M.H.S., of the Massachusetts General Hospital, Boston, and coauthors

(doi:10.1001/jamapsychiatry.2019.2285)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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What Is Risk of New Long-Term Opioid Use Among Patients With Hidradenitis Suppurtiva?

Posted September 9, 2019 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 11, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: Hidradenitis suppurativa is a painful skin condition where lumps form under the skin. This observational study examined the risk of new long-term opioid use among patients with the condition who hadn’t previously used opioids.

Authors: Amit Garg, M.D., of the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New Hyde Park, New York, is the corresponding author.

(doi:10.1001/jamadermatol.2019.2610)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Is Time Spent Using Social Media Associated With Mental Health Problems Among Adolescents?

Posted September 9, 2019 by Jim Michalski

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 11, 2019

Media advisory: To contact corresponding author Kira E. Riehm, M.S., email Caitlin Hoffman at choffman@jhu.edu. The full study and podcast are linked to this news release.

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Bottom Line: Adolescents who spend more than three hours a day using social media may be at higher risk for mental health problems. This observational study included a nationally representative sample of nearly 6,600 U.S. adolescents (ages 12-15) who reported time spent on social media during a typical day and who reported information about mental health problems. After accounting for factors including a history of mental health problems, study authors report that adolescents who used social media more than three hours a day were more likely to report internalizing problems (these can include depression, anxiety and loneliness), as well as symptoms of both internalizing and externalizing (such as aggression and antisocial behavior) problems but not externalizing problems alone compared with adolescents who reported no social media use. Limitations of the study include that time spent on social media and information about internalizing and externalizing problems were self-reported, and other factors not accounted for by study authors may help to explain the results.

Authors: Kira E. Riehm, M.S., Johns Hopkins University, Baltimore, and coauthors.

(doi:10.1001/jamapsychiatry.2019.2325)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Association of Positive Childhood Experiences and Adult Mental Health, Depression

Posted September 5, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 9, 2019

Media advisory: To contact corresponding author Christina Bethell, Ph.D., M.B.A., M.P.H., email Barbara Benham at bbenham1@jhu.edu. The full study is linked to this news release.

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Bottom Line: Reporting more positive childhood experiences was associated with a lower likelihood of adult depression or poor mental heath, or both, and a greater likelihood of adults reporting social and emotional support even after accounting for adverse childhood experiences in this observational study based on survey data representative of the entire population of adults in Wisconsin in 2015. Positive childhood experiences included seven interpersonal experiences with family, friends and in school or in the community, such as a sense of belonging, feeling protected and the ability to express feelings. Limitations of the study include its inability to confirm causal effects and that the adult population of Wisconsin is less diverse than the United States as a whole. Study authors suggest positive childhood experiences could have lifelong effects on mental and relational health.

Author: Christina Bethell, Ph.D., M.B.A., M.P.H., of the Johns Hopkins University Bloomberg School of Public Health, Baltimore, and coauthors

(doi:10.1001/jamapediatrics.2019.3007)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Differences Between Women, Men Surgeons in Perceived Career Barriers

Posted September 9, 2019 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 11, 2019

Media advisory: To contact corresponding author Nicole K. Zern, M.D., email Susan Gregg at sghanson@uw.edu. The full study is linked to this news release.

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Bottom Line: Faculty and resident surgeons were surveyed to examine differences between men and women in perceived career barriers. For the study, 140 faculty and resident physicians (90 men, 50 women) at the University of Washington in Seattle were surveyed. Perceived career barriers reported by women at a higher rate included lack of mentors or role models, a lack of confidence, the desire to have children, and childcare concerns. More women than men also reported experiencing sex discrimination. None of the men identified their sex as a career barrier, while 13 women did. A potential limitation of the study is that the survey was completed by members of a single department at a single university.

Authors: Nicole K. Zern, M.D., University of Washington, Seattle, and coauthors

(doi:10.1001/jamasurg.2019.2648)

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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Is Ownership of Dialysis Facilities Associated With Access to Kidney Transplants?

Posted September 5, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 10, 2019

Media advisory: To contact corresponding author Rachel E. Patzer, Ph.D., M.P.H., email Janet Christenbury at jmchris@emory.edu. The full study and editorial are linked to this news release.

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Bottom Line: An analysis that included data for nearly 1.5 million patients with end-stage kidney disease looked at whether ownership of dialysis facilities was associated with patients’ access to kidney transplants. This observational study included patients treated at 6,511 dialysis facilities in the United States from 2000-2016. The authors report that receiving dialysis at for-profit compared with nonprofit facilities was associated with lower likelihood of being placed on the deceased donor kidney waiting list, receiving a deceased donor kidney transplant, and receiving a living donor kidney transplant. More research is needed to understand the reasons behind this association. Limitations of the study include an inability to determine differences regarding staffing resources, education policies and transplant referral practices, which may be associated with increased access to kidney transplantation. The study also couldn’t identify patients truly eligible for transplantation.

Authors: Rachel E. Patzer, Ph.D., M.P.H., Emory University School of Medicine, Atlanta, and coauthors

(doi:10.1001/jama.2019.12803)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Online Crowdfunding to Pay for Cancer Care

Posted September 5, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 9, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This research letter examined crowdfunding efforts to defray expenses associated with cancer care.

Authors: Benjamin N. Breyer, M.D., M.A.S., F.A.C.S., of the University of California, San Francisco, is the corresponding author.

(doi:10.1001/jamainternmed.2019.3330)

Editor’s Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Here’s a link to provide your readers free access to the full-text article

Posted September 5, 2019 by Deanna Bellandi

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Evidence of Herd Protection Against Oral HPV Infections Among Unvaccinated U.S. Adults

Posted September 5, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 10, 2019

Media advisory: To contact corresponding author Maura L. Gillison, M.D., Ph.D., email Meagan Raeke at MERaeke@mdanderson.org. The full study is linked to this news release.

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Bottom Line: HPV vaccination has been recommended for U.S. females since 2006 and since 2011 for males to prevent anogenital HPV infections and associated cancers. Prevention of oral HPV infections and associated cancers of the mouth and throat is not a vaccine indication due to lack of clinical trials. Therefore, study investigators generated nationally representative data on oral HPV infections in the U.S. from 2009-2016 to look for evidence of herd protection in unvaccinated men and women ages 18 to 59. Vaccination rates increased among men and women during the study period. Study authors report the prevalence of vaccine-type oral HPV infections (e.g. those included in the vaccine) declined from 2.7% to 1.6% in unvaccinated men, with no change in nonvaccine-type HPV infections. Oral HPV infections in unvaccinated women remained unchanged for both vaccine- and nonvaccine-types. The findings suggest herd protection among men against oral HPV infections, which the authors say is likely due to the increased level of HPV vaccination in women. The apparent lack of herd protection among unvaccinated women may be because of low statistical power in the study due to a low prevalence of oral HPV infections in women. A limitation of the study is the use of self-reported information on HPV vaccination.

Authors: Maura L. Gillison, M.D., Ph.D., MD Anderson Cancer Center, Houston, and coauthors at the National Cancer Institute

(doi:10.1001/jama.2019.10508)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Here’s a link to provide your readers free access to the full-text article

Posted August 30, 2019 by Jim Michalski

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Here’s a link to provide your readers free access to the full-text article

Posted August 30, 2019 by Jim Michalski

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Study Presented at European Society of Cardiology Congress

Posted August 29, 2019 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 10:40 A.M. (ET), TUESDAY, SEPTEMBER 3, 2019

Media advisory: The study linked to this news release was released to coincide with presentation at the European Society of Cardiology Congress 2019 in Paris.

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Study Presented at European Society of Cardiology Congress

Posted August 30, 2019 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 8:30 A.M. (ET), SUNDAY, SEPTEMBER 1, 2019

Media advisory: The European Society of Cardiology Congress 2019 is being held in Paris and the study and commentary linked to this news release are being released to coincide with presentation.

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Study Presented at European Society of Cardiology Congress

Posted August 30, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 5 A.M. (ET), MONDAY, SEPTEMBER 2, 2019

Media advisory: The study linked to this news release was released to coincide with presentation at the European Society of Cardiology Congress 2019 in Paris.

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Studies Presented at European Society of Cardiology Congress

Posted August 29, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 2:30 A.M. (ET), MONDAY, SEPTEMBER 2, 2019

Media advisory: The studies and editorials linked to this news release were released to coincide with presentation at the European Society of Cardiology Congress 2019 in Paris.

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Association of Metabolic Surgery With Major Adverse Cardiovascular Outcomes in Patients With Type 2 Diabetes and Obesity: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.14231?guestAccessKey=135a92ef-8e23-4dc5-90f4-17100351f107&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090219

Association of Change in N-Terminal Pro–B-Type Natriuretic Peptide Following Initiation of Sacubitril-Valsartan Treatment With Cardiac Structure and Function in Patients With Heart Failure With Reduced Ejection Fraction: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.12821?guestAccessKey=5bd0d473-87aa-4e77-9027-a9e544274e8e&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090219

Effect of Sacubitril-Valsartan vs Enalapril on Aortic Stiffness in Patients With Heart Failure and Reduced Ejection Fraction: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.12843?guestAccessKey=61134750-7788-47bb-bcd9-81c3b1f51ede&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090219

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Transgender, Gender-Nonbinary Teens in China Report Abuse, Neglect, Bullying

Posted September 3, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 6, 2019

Media advisory: To contact corresponding author Runsen Chen, M.Sc., M.B.M.S., email runsen.chen@psych.ox.ac.uk. The full study and commentary are linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Most transgender and gender-nonbinary teens in China who participated in a national survey study reported abuse, neglect or bullying at home and in school, which the researchers suggest may be due in part to the socially conservative values prevalent in the country. The study included 385 adolescents (average age nearly 17) who responded to an online survey. Among the 319 teens who reported their parents knew their gender identity, 92% reported experiencing parental abuse or neglect and, among all the teens, 76.6% reported abuse or bullying at school from classmates or teachers. Limitations of the study include that survey questionnaires were only accessible to teens with internet access and all the study measures were self-reported and done over the internet.

Authors: Runsen Chen, M.Sc., M.B.M.S., of the National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University in Beijing, and coauthors

(doi:10.1001/jamanetworkopen.2019.11058)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Is Exposure to World Trade Center Disaster Associated With Cardiovascular Disease Risk for NY Firefighters?

Posted September 3, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 6, 2019

Media advisory: To contact corresponding author Rachel Zeig-Owens, Dr.P.H., M.P.H., email Frank Gribbon at Francis.Gribbon@fdny.nyc.gov. The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.9775?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=090619

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: A study of nearly 9,800 Fire Department of the City of New York (FDNY) male firefighters suggests an association between greater exposure to the World Trade Center disaster and long-term cardiovascular disease risk, while the results of other studies have been mixed. This study used two measures of exposure to the World Trade Center disaster (arrival time and work duration at the site) to examine the primary outcome of long-term risk of cardiovascular disease, which included heart attack, stroke, unstable angina, coronary artery surgery or angioplasty, or death from cardiovascular disease. Study authors report 489 primary outcomes among the 9,796 male firefighters in more than 16 years of follow-up. Both acute exposure (arriving at the site on the morning of the 9/11 attacks) and repeated exposure during six or more months of work at the site appear to be associated with higher risk of cardiovascular disease compared with those firefighters who arrived later and worked for less time at the site. The associations were statistically significant after accounting for well-established risk factors of cardiovascular disease. Limitations of the study include that the risk of long-term cardiovascular disease in these firefighters could be attributed to their stressful jobs and exposure to smoke and dust in subsequent fires. The authors suggest the findings reinforce the importance of long-term health monitoring for survivors of disasters like the 9/11 attacks on the World Trade Center.

Authors: Rachel Zeig-Owens, Dr.P.H., M.P.H., and David J. Prezant, M.D., of the Fire Department of the City of New York, and coauthors

(doi:10.1001/jamanetworkopen.2019.9775)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Has Racial/Ethnic Representation Changed Among U.S. Medical Students?

Posted August 30, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 4, 2019

Media advisory: To contact corresponding authors Ronnie Sebro, M.D., Ph.D., and Jaya Aysola, M.D., M.P.H., email Lauren Ingeno at lauren.ingeno@pennmedicine.upenn.edu. The full study and commentary are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10490?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=090419

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: This analysis reports black, Hispanic and American Indian or Alaska Native students remain underrepresented in allopathic medical schools when compared with the U.S. population, despite new diversity accreditation guidelines. The study used self-reported data on race/ethnicity and sex for medical school applicants and enrolled students (matriculants) from 2002 to 2017. New diversity accreditation guidelines were instituted in 2009 by the Liaison Committee on Medical Education. From 2002 to 2017, the number of medical school applicants increased 53.6% to nearly 51,658 and the number of matriculants increased 29.3% to 21,326. Absolute numbers and proportions of racial/ethnic minority medical school applicants and matriculants have ticked up over time but haven’t kept pace with the makeup of their comparable age group in the U.S. population resulting in underrepresentation. Limitations of the study include limits of the data used. The authors suggest more robust policies and programs are needed to create a physician workforce representative of the U.S. population and progress toward that goal must be tracked.

Authors: Ronnie Sebro, M.D., Ph.D., and Jaya Aysola, M.D., M.P.H., of the University of Pennsylvania, Philadelphia, and coauthors

(doi:10.1001/jamanetworkopen.2019.10490)

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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Study Examines Suicide at County Level in U.S.

Posted September 3, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 6, 2019

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10936?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=090619

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

What The Study Did: This study examined patterns of suicide in the United States at the county level during an 18-year period and looked at associated geographic and community-level factors. Between 1999 and 2016, 453,577 people ages 25 to 64 died by suicide.

Authors: Danielle L. Steelesmith, Ph.D., of the Ohio State University Wexner Medical Center in Columbus, is the corresponding author

(doi:10.1001/jamanetworkopen.2019.10936)

Editor’s Note: The article includes conflict of interest disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Racial/Ethnic Differences in Emergency Department Destination of EMS for Patients Living in Same Area

Posted September 3, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 6, 2019

Media advisory: To contact corresponding author Amresh D. Hanchate, Ph.D., email David Kibbe at david.kibbe@bmc.org. The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10816?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=090619

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Black and Hispanic Medicare patients transported by emergency medical services (EMS) to an emergency department (ED) were less likely to go to the same ED as white Medicare patients living in the same area. Evidence from previous studies has suggested differences in hospitals where racial/ethnic minorities receive care. Using Medicare claims data, this study looked at patterns of ED destination of EMS transport according to patient race/ethnicity and by zip code. The analysis included nearly 865,000 Medicare patients from 4,175 zip codes who had about 460,000 ED visits using EMS transport from 2006 to 2012. Authors report the proportion of white patients transported to the most frequent ED destination was 61.3%, while the proportion was 5.3% lower for black patients and 2.5% lower for Hispanic patients. A similar pattern was found among patients with high-risk acute conditions. Black and Hispanic Medicare patients also were more likely to be transported to a safety-net ED compared to white Medicare patients from the same zip code. Study limitations include that for certain clinical conditions (such as trauma, stroke and cardiac events), guidelines may require transportation to a suitable ED, which may not be near a patient’s home.

Authors: Amresh D. Hanchate, Ph.D., Boston University School of Medicine, and coauthors

(doi:10.1001/jamanetworkopen.2019.10816)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Is Childhood Criminal Justice Exposure Associated With Risk of Poor Adult Mental Health?

Posted August 30, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 4, 2019

Media advisory: To contact corresponding author Nia Heard-Garris, M.D., M.Sc., email Julie Pesch at JPesch@luriechildrens.org. The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10465?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=090419

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: A childhood history of both personal involvement in the juvenile justice system and parental incarceration was associated with a greater likelihood of depression, anxiety and posttraumatic stress disorder in young adulthood compared to peers without those experiences in this observational study. And, having either one of those experiences with the criminal justice system as a child was associated with risk of adverse mental health outcomes. This analysis of a nationally representative survey included 12,379 participants (141 reported experiencing both parental incarceration and juvenile justice involvement) who were in grades 7 to 12 in 1994-1995 and who were 24 to 32 years old at follow-up in 2008. The study didn’t account for the nature of offenses contributing to parental incarceration or involvement in the juvenile justice system or the duration of childhood exposure to the criminal justice system. The focus also was on incarceration of biological parents, which doesn’t account for children who experienced the incarceration of nonbiological caregivers. Study authors suggest that because childhood exposure to the criminal justice system appears to put people at risk for poor mental health outcomes later, policies to mitigate that impact could help improve their mental well-being as adults.

Authors: Nia Heard-Garris, M.D., M.Sc., of the Ann & Robert H. Lurie Children’s Hospital of Chicago, and coauthors

(doi:10.1001/jamanetworkopen.2019.10465)

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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Comparing Opioid Prescription Fills After Surgery Across Countries

Posted August 30, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 4, 2019

Media advisory: To contact corresponding author Mark D. Neuman, M.D., M.Sc., email Mike Iorfino at Mike.Iorfino@pennmedicine.upenn.edu. The full study and commentary are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10734?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=090419

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Higher proportions of patients in the United States and Canada filled opioid prescriptions after surgery compared with Sweden. This analysis examined differences in rates of opioid prescriptions filled after low-risk surgical procedures (laparoscopic removal of the gallbladder or appendix, arthroscopic knee meniscus surgery and breast excision) among 129,000 patients in the United States, 84,000 patients in Canada and 9,800 in Sweden. The authors report the proportion of patients who filled an opioid prescription within the first seven days after being discharged from the hospital was 76.2% in the United States, 78.6% in Canada and 11.1% in Sweden. The average dose of opioids for most surgical procedures was highest in the United States. Limitations of the study include a lack of information about pain experiences of patients after surgery so the quality of pain treatment across counties couldn’t be examined.

Authors: Mark D. Neuman, M.D., M.Sc., University of Pennsylvania Perelman School of Medicine, Philadelphia, and coauthors

(doi:10.1001/jamanetworkopen.2019.10734)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Here’s a link to provide your readers free access to the full-text article

Posted August 29, 2019 by Deanna Bellandi

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2019.2764?guestAccessKey=9b87c95c-5a3f-4fac-8389-6ca58a131657&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090319

Research Letter Focuses on Association of Inflammation in Late Adolescence With Death Over 3 Decades

Posted August 29, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 3, 2019

Media advisory: The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article: This link will be live at the embargo time: https://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2019.2835?guestAccessKey=5a6623c3-b436-4e80-a12f-124985bc49f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090319

What The Study Did: This study used a blood marker of inflammation to assess the association of inflammation in late adolescence with death among a group of apparently healthy men (born between 1952 and 1956) who had blood drawn for compulsory conscription in the Swedish Army (at ages 16 to 20) and who were observed up to age 57.

Author: Elizabeth D. Kantor, Ph.D., M.P.H., of the Memorial Sloan Kettering Cancer in New York, is the corresponding author.

(doi:10.1001/jamapediatrics.2019.2835)

Editor’s Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Pain Medication Use by Children After Common Surgeries

Posted August 30, 2019 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 4, 2019

Media advisory: To contact corresponding author Calista M. Harbaugh, M.D., M.S., email Kara Gavin at kegavin@med.umich.edu. The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2019.2529?guestAccessKey=8fa0670e-14d3-4147-82d9-55671dd04810&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090419

Bottom Line: About 400 caregivers reported pain medication use by children after common surgeries such as hernia, elbow fracture, appendectomy or adenoid removal in this study. Most reported using acetaminophen or ibuprofen or both; 88 patients (22%) were prescribed an opioid at hospital discharge and most used less than prescribed. The lack of an opioid prescription wasn’t associated with poor pain control, a postdischarge opioid prescription or a pain-related visit to an emergency department for patients. Limitations of the study include that it was conducted at a single center and patients weren’t randomized.

Authors: Calista M. Harbaugh, M.D., M.S., University of Michigan, Ann Arbor, and coauthors

(doi:10.1001/jamasurg.2019.2529)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations

Soft Drinks Associated With Risk of Death in Population-Based Study in 10 European Countries

Posted August 29, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 3, 2019

Media advisory: To contact corresponding author Neil Murphy, Ph.D., email murphyn@iarc.fr. The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2019.2478?guestAccessKey=b99410a9-8afc-4953-b328-bbb2620dfacd&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090319

Bottom Line: Greater consumption of soft drinks, including both sugar- and artificially sweetened, was associated with increased risk of overall death in a population-based study of nearly 452,000 men and women from 10 European countries. Drinking two or more glasses per day (compared with less than one glass per month) of total soft drinks, sugar-sweetened soft drinks and artificially sweetened soft drinks was associated with higher risk of death from all causes during an average follow-up of 16 years in which 41,693 deaths occurred. The study group included participants from Denmark. France, Germany, Greece, Italy, the Netherlands, Norway, Spain, Sweden and the United Kingdom. Soft drink consumption was collected on food questionnaires or in interviews at baseline from 1992 to 2000. Also among the findings was a higher risk of death from circulatory diseases associated with consuming two or more glass per day of total and artificially sweetened soft drinks, and a higher risk of death from digestive diseases associated with drinking one or more glass per day of total and sugar-sweetened soft drinks. No association was observed between soft drink consumption and overall cancer death. Limitations of the study include its observational design, which makes causal inferences impossible, and there was only a single assessment of soft drink consumption. Study authors suggest the findings support public health initiatives to limit soft drink consumption.

Authors: Neil Murphy, Ph.D., of the International Agency for Research on Cancer, Lyon, France, and coauthors

(doi:10.1001/jamainternmed.2019.2478)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Here’s a link to provide your readers free access to the full-text article

Posted August 27, 2019 by Deanna Bellandi

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10326?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=083019

Use of Medical Imaging

Posted August 29, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 3, 2019

Media advisory: To contact corresponding author Rebecca Smith-Bindman, M.D., email Elizabeth Fernandez at Elizabeth.Fernandez@ucsf.edu. The full study and editorial are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.11456?guestAccessKey=77acf4af-383a-4cfb-8dae-890607ccf367&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090319

Bottom Line: This observational study looked at patterns of use for computed tomography (CT), magnetic resonance imaging (MRI), ultrasound and nuclear medicine imaging in the United States and in Ontario, Canada, from 2000 to 2016. Medical imaging use increased rapidly from 2000 to 2006 and this analyzes its use in more recent years among 16 million to 21 million patients enrolled in seven U.S. health care networks and for patients in Ontario, Canada. The analysis included 135 million imaging examinations. Among adults over 18, imaging rates were higher in 2016 compared with 2000 for all types except nuclear medicine, which has declined in use among adults and children since 2006. Among children, imaging rates continued to increase except for CT, which has declined since 2006. Limitations of the study include U.S. patients enrolled in health care systems that used HMO models of care, which may not represent imaging use among patients covered by other plans. Also, the reason for imaging wasn’t available so it’s impossible to know if the imaging was appropriate.

Authors: Rebecca Smith-Bindman, M.D., University of California, San Francisco, and coauthors

(doi:10.1001/jama.2019.11456)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. 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 Network Media Relations at 312-464-JAMA (5262) or email mediarelations

USPSTF Recommendation on Medications to Reduce Breast Cancer Risk

Posted August 29, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 3, 2019

Media advisory: To contact the U.S. Preventive Services Task Force, email the Media Coordinator at Newsroom@USPSTF.net or call 202-572-2044. The full report, related articles and podcast are linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time and all USPSTF articles remain free indefinitely: https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2019.11885?guestAccessKey=2cee0cc3-712b-4d98-819b-0ad8d900551e&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=090319

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) added aromatase inhibitors to its recommendation that clinicians offer medications to reduce the risk of breast cancer (tamoxifen, raloxifene or aromatase inhibitors) to asymptomatic women 35 and older, including those with previous benign breast lesions, who are at increased risk of developing the disease but at low risk for adverse effects from the medications. The USPSTF recommends against routine use of these medications in women not at increased risk for breast cancer. This recommendation doesn’t apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ. This statement is an update of its 2013 recommendation.

The USPSTF Concludes:

(doi:10.1001/jama.2019.11885)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Note: More information about the U.S. Preventive Services Task Force, its process, and its recommendations can be found on the newsroom page of its website.

# # #

For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Outcomes After Donor Kidneys Declined by Transplant Centers on Patients’ Behalf

Posted August 27, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 30, 2019

Media advisory: To contact corresponding author Sumit Mohan, M.D., M.P.H., email Helen Garey, M.P.H., at hbg3@cumc.columbia.edu. The full study is linked to this news release.

Embed this link to provide your readers free access to the full-text article This link will be live at the embargo time: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2019.10312?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=083019

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: This observational study used United Network for Organ Sharing data to examine how wait-listed kidney transplant candidates fared after deceased donor kidneys were offered but declined by transplant centers on patients’ behalf. The study included 280,041 wait-listed patients who received at least one donor kidney offer between 2008 and 2015. Among the patients, 81,750 received a deceased donor kidney transplant; 30,870 received a kidney from a living donor; 25,967 died on the waiting list; 59,359 were removed from the waiting list; and 82,095 remained on the waiting list. Most kidneys (84 percent) were declined on behalf of at least one candidate before eventually being accepted for transplant into other patients with lower priority on the match list. Concerns over organ or donor quality accounted for about 93 percent of all declined donor kidney offers. Study authors report patients who received a deceased donor kidney had a median of 17 organ offers before transplant, those who died on the waiting list had a median of 16 offers, and those who were removed from the list had a median of 15 organ offers. The study estimates that overall 10 patients with at least one previous offer of a donor kidney died each day during the study period. The odds of dying on the waiting list after receiving an offer of a kidney varied across the United States. The results suggest declined deceased donor kidney offers appear to be missed opportunities for transplants for some patients. Limitations of the study include a lack of detail for reasons reported by transplant centers for declining organ offers and limited data since 2014 when the criteria for prioritizing patients for certain organs changed.

Authors: Sumit Mohan, M.D., M.P.H., Columbia University Irving Medical Center, New York, and coauthors

(doi:10.1001/jamanetworkopen.2019.10312)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Does Appointment Time Influence Primary Care Opioid Prescribing?

Posted August 27, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 30, 2019

Media advisory: To contact corresponding author Hannah T. Neprash, Ph.D., email Sarah Bjorkman at bjor0180@umn.edu. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Physicians at primary care appointments were more likely to prescribe opioids for pain later in the day and as appointments ran more behind schedule, although the absolute difference in the prescribing rate across the day was modest in this analysis of electronic health records. The observational study included 678,319 primary care appointments for patients with a new painful condition who hadn’t received an opioid prescription within the past year. The likelihood that an appointment resulted in an opioid prescription increased from 4% in the first three appointments of the day to 5.3% later on at the 19^th to 21^st appointments; and from 4.4% for appointments running less than 10 minutes late to 5.2% for appointments at least 60 minutes late. Similar patterns weren’t observed for prescriptions for nonsteroidal anti-inflammatory drugs and referrals to physical therapy. Limitations of the study include other unobserved reasons patients may be prescribed opioids.

Authors: Hannah T. Neprash, Ph.D., of the University of Minnesota School of Public Health in Minneapolis, is the corresponding author.

(doi:10.1001/jamanetworkopen.2019.10373)

Editor’s Note: The study includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Here’s a link to provide your readers free access to the full-text article

Posted August 26, 2019 by Deanna Bellandi

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Here’s a link to provide your readers free access to the full-text article

Posted August 26, 2019 by Deanna Bellandi

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Posted August 26, 2019 by Deanna Bellandi

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Estimate of Cigarette Consumption in England

Posted August 26, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 28, 2019

Media advisory: To contact corresponding author Sarah E. Jackson, Ph.D., email s.e.jackson@ucl.ac.uk. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Estimated total cigarette consumption in England fell by almost one-quarter between 2011 and 2018 in a study comparing survey and sales data. That estimated decline is equal to about 1.4 billion cigarettes per year. Cigarette smoking is a leading risk factor for illness and death worldwide. Limitations of the study include data that may have overestimated or underestimated cigarette consumption, and the study focused only on cigarettes and not other tobacco products or nicotine alternatives such as electronic cigarettes.

Authors: Sarah E. Jackson, Ph.D., University College London, United Kingdom, and coauthors

(doi:10.1001/jamanetworkopen.2019.10161)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Posted August 26, 2019 by Deanna Bellandi

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Do British Teens Meet Recommended Guidelines for Sleep, Physical Activity, Screen-Time?

Posted August 22, 2019 by Jim Michalski

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 26, 2019

Media Advisory: To contact corresponding author Natalie Pearson, Ph.D., email n.l.pearson@lboro.ac.uk. The full study is linked to this news release.

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Bottom Line: Understanding how many British adolescents meet recommendations for sleep, screen time and moderate to vigorous physical activity was the focus of this study. Data from 3,899 adolescents were included. Recommended guidelines include more than eight hours of sleep on a school night, screen time of less than two hours per day, and 60 minutes a day or more of physical activity. The amount of sleep and screen time were self-reported and physical activity was assessed using a wrist-worn activity monitor. The authors report 378 (9.7%) of the adolescents met all three recommendations. Screen time was the main reason for not meeting all the recommendations. Of the participants, 89.3% met the guideline for sleep, 40.5% for activity and 23.1% for screen time. Those less likely to meet all three recommendations included boys and girls with depressive symptoms and boys who were obese.

Authors: Natalie Pearson, Ph.D., Loughborough University, Loughborough, United Kingdom, and coauthors.

(doi:10.1001/jamapediatrics.2019.2822)

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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Study Examines Alcohol Consumption, Risk of Dementia in Older Adults

Posted September 24, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 27, 2019

Media advisory: To contact corresponding author Majken K. Jensen, Ph.D., email Christopher Sweeney at csweeney@hsph.harvard.edu. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: This observational study examined alcohol consumption and the risk of dementia and cognitive decline in older adults with or without mild cognitive impairment (MCI). The study analyzed 3,021 adults (72 and older) who were free of dementia (2,548 were without MCI and 473 with MCI). During about six years of follow-up, there were 512 cases of dementia, including 348 cases of Alzheimer disease. Among those adults without MCI, no amount of alcohol consumption was significantly associated with higher risk for dementia compared with drinking less than one drink per week. Among those adults with MCI, the risk of dementia according to numbers of alcoholic drinks per week wasn’t statistically significant, although it appeared to be highest for drinking more than 14 drinks per week compared with less than one drink. The association between alcohol intake and cognitive decline was affected by the presence of MCI at the study start. Difference in scores reflecting cognitive decline at follow-up by alcohol consumption were statistically significant only among those with MCI at baseline, with the biggest decline associated with more than 14 drinks per week. Limitations of the study include self-reported alcohol consumption. The findings warrant further study and physicians should address the drinking behavior when caring for older patients.

Authors: Majken K. Jensen, Ph.D., Harvard T.H. Chan School of Public Health, Boston, and coauthors

(doi:10.1001/jamanetworkopen.2019.10319)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Education Associated With Life Expectancy Among U.S. Adults

Posted August 22, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 27, 2019

Media advisory: To contact corresponding author Isaac Sasson, Ph.D., email isasson@tauex.tau.ac.il. The full study is linked to this news release.

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Bottom Line: This observational study estimates life expectancy at age 25 and to what extent causes of death are associated with differences in life expectancy based on the level of education attained by U.S. adults. The analysis included 2.2 million deaths in 2010 and 2.4 million deaths in 2017. Between those years, life expectancy at age 25 declined overall from 79.34 to 79.15 years in an analysis limited to white and black non-Hispanic adults because other racial/ethnic groups were too small or less reliably identified in the national vital statistics system. While life expectancy decreased for white adults, it didn’t change significantly for black men and it increased among black women. Life expectancy decreased among adults with less than a four-year college degree and increased among the college educated. Much of the increasing educational differences in years of life lost may be related to deaths from drug use, especially among white men and women. Some limitations of the study are related to the nature of the data used.

Authors: Isaac Sasson, Ph.D., Tel Aviv University, and Mark D. Hayward, Ph.D., University of Texas at Austin

(doi:10.1001/jama.2019.11330)

Editor’s Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Is Eating Plant Protein Associated With Lower Risk of Death?

Posted August 22, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 26, 2019

Media advisory: To contact corresponding author Norie Sawada, M.D., Ph.D., email nsawada@ncc.go.jp. The full study is linked to this news release.

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Bottom Line: Eating plant protein was associated with lower risk of death in a Japanese population in this observational study. The study included 70,696 people, the majority of whom were women, with an average age of about 55. It examined associations between eating animal and plant protein and the risk of death overall and from specific causes. Information on what people ate came from a food questionnaire; data were collected from 1995 through 1999 and follow-up was completed through 2016, during which time there were 12,381 deaths documented. Study authors report that eating animal protein wasn’t associated with mortality outcomes but higher intake of plant protein was associated with lower risk of death overall and death related to cardiovascular disease. Replacing red meat protein or processed meat protein with plant protein was associated with lower risk of death overall and death related to cancer and cardiovascular disease. Limitations of the study include a single assessment of dietary information so eating habits may have changed over time and participants with chronic disease were excluded from the study. The study suggests encouraging diets with more intake of plant-based protein could contribute to better health and longevity.

Authors: Norie Sawada, M.D., Ph.D., of the Center for Public Health Sciences, National Cancer Center, Tokyo, and corresponding authors

(doi:10.1001/jamainternmed.2019.2806)

Editor’s Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Are Laws Against Positive Portrayals of Sexual Minorities in Public Schools Associated With e-Cigarette Use?

Posted August 22, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 26, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This study used national youth survey data to examine associations between electronic cigarette use among sexual minority and heterosexual adolescents and laws that prohibit positive portrayals of sexual minority individuals or nonheterosexual activities in public school education (the so-called no promotion of homosexuality laws).

Author: Lexie Willis, B.S., and Mike C. Parent, Ph.D., of the University of Texas at Austin, are the authors.

(doi:10.1001/jamapediatrics.2019.2729)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Former NFL Players With History of Concussion Symptoms More Likely to Report Low Testosterone, Erectile Dysfunction

Posted August 22, 2019 by Jim Michalski

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 26, 2019

Media Advisory: To contact corresponding author Rachel Grashow, Ph.D., M.S., email Ekaterina Pesheva at Ekaterina_Pesheva@hms.harvard.edu. The full study and podcast are linked to this news release.

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Bottom Line: In a study of 3,409 former NFL players, a self-reported history of concussion symptoms was associated with an increased likelihood of self-reported low testosterone levels and erectile dysfunction (ED), even among those players reporting relatively few concussion symptoms when they were injured. Previous studies have suggested head trauma in men may be associated with low testosterone levels and sexual dysfunction, possibly because of trauma-induced damage to the pituitary gland. In this study, former football players were surveyed about experiencing concussion symptoms while playing or practicing professional football and, if they had, how many times. In addition, they were asked if a health care provider ever recommended or prescribed medication for low testosterone or ED and if they were currently taking medication for those conditions. Of the players, 18.3% had indicators for low testosterone levels and 22.7% had indicators of ED. Former players in the group reporting the highest number of concussion symptoms were about twice as likely to report low testosterone compared to those with the fewest symptoms; the association was similar for ED in analyses that accounted for demographic, current health and football-related factors including position played. The study has a number of limitations, including indirect measures of low testosterone levels and ED, and concussion data that were collected after a player’s career ended and that relied on memory recall. Also, it isn’t known whether the men had low testosterone levels or ED before they started playing in the NFL. The study authors suggest their findings might encourage clinicians to ask men with brain injuries about the treatable conditions of low testosterone levels and ED.

Authors: Rachel Grashow, Ph.D., M.S., Harvard School of Public Health, Boston, and coauthors

(doi:10.1001/jamaneurol.2019.2664)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Deaths in U.S. From Heart Disease, Stroke, Diabetes, Hypertension Examined

Posted August 22, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 27, 2019

Media advisory: To contact corresponding author Sadiya S. Khan, M.D., M.Sc., email Kristin Samuelson at ksamuelson@northwestern.edu. The full study is linked to this news release.

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Bottom Line: Heart disease, stroke, diabetes and hypertension death rates (adjusted for age to account for different ages in the population) were examined from 1999 to 2017 in the United States in this study that used data from the Centers for Disease Control and Prevention. Researchers report the overall rate of death from heart disease decreased over time but the rate of decline slowed after 2010; deaths from stroke and diabetes declined from 1999 to 2010 but leveled off after that; and deaths from high blood pressure increased between 2010 and 2017. Black individuals had higher age-adjusted mortality rates compared with whites. A limitation of the study is the use of death certificate data, which can be miscoded.

Authors: Sadiya S. Khan, M.D., M.Sc., Northwestern University Feinberg School of Medicine, Chicago, and coauthors

(doi:10.1001/jama.2019.9161)

Editor’s Note: The article includes funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Estimates of Potential Gains if U.S. Had Less Restrictive Acceptance Practices for Donor Kidneys

Posted August 22, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 26, 2019

Media advisory: To contact corresponding author Alexandre Loupy, M.D., Ph.D., email put Sylvie Delassus at Syl.delassus@gmail.com. The full study and commentary are linked to this news release.

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Bottom Line: A study of donated kidneys from deceased donors in the United States and France between 2004 and 2014 estimates the effect of less restrictive acceptance practices for organ donation like those in France on the donor pool and potential survival benefits for wait-listed U.S. patients. The authors of this observational study report 156,089 kidneys were recovered from deceased donors in the United States during that period, of which 128,102 were transplanted and 27,987 (17.9%) were discarded. In France, 29,984 kidneys were recovered during that time with 27,252 transplanted and 2,732 (9.1%) discarded. The average age of donors in France was higher (56 compared with 39 in the United States by 2014) and France accepted lower-quality kidneys for transplantation. The analyses suggests that if the French-based organ allocation model was applied to deceased donor kidneys in the United States, then 17,435 (62%) of discarded kidneys could have been transplanted and provided potentially years of added survival for patients. Limitations of the study include that analysis of data from 2004 to 2014 cannot assess if the new organ allocation system implemented in 2014 in the United States impacted organ utilization but another study suggests the kidney discard rate didn’t improve after 2014 when changes to kidney allocation were implemented.

Authors: Alexandre Loupy, M.D., Ph.D., of the Paris Translational Research Center for Organ Transplantation, and corresponding authors

(doi:10.1001/jamainternmed.2019.2322)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Posted August 20, 2019 by Deanna Bellandi

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Here’s a link to provide your readers free access to the full-text article

Posted August 20, 2019 by Deanna Bellandi

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What is Quality, Readability of Online Information on Diabetic Retinopathy?

Posted August 20, 2019 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 22, 2019

Media advisory: The full study and commentary are linked to this news release.

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What The Study Did: Information from 11 diabetic retinopathy websites was analyzed to assess quality, accuracy and readability for patients seeking information about this complication of diabetes that affects the eyes.

Authors: Jayanth Sridhar, M.D., of the University of Miami Miller School of Medicine in Miami is the corresponding author.

(doi:10.1001/jamaophthalmol.2019.3116)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Here’s a link to provide your readers free access to the full-text article

Posted August 19, 2019 by Deanna Bellandi

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Assessing Black Patients’ Perceptions of Dermatology Care

Posted August 19, 2019 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 21, 2019

Media advisory: The full study, editorial and podcast are linked to this news release.

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What The Study Did: This study of 19 adult black patients involving a survey and focus groups examined black patients’ perceptions of experiences with dermatologists in a specialized clinic for treating skin of color and conventional dermatology clinics.

Authors: Stavonnie Patterson, M.D., of the Northwest Community Hospital Medical Group, Arlington Heights, Illinois, is the corresponding author.

(doi:10.1001/jamadermatol.2019.2063)

Editor’s Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Parental Incarceration Associated With Kids’ Psychiatric, Functional Outcomes in Young Adults

Posted August 19, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 23, 2019

Media advisory: To contact corresponding author William E. Copeland, Ph.D., email Michael Carrese at michael.carrese@uvmhealth.org. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Incarceration during childhood of a parental figure (biological, adopted or stepparents or any adult responsible for a child’s care and discipline) appears to be associated with children’s psychiatric, legal, financial and social outcomes as young adults. This observational study used data from parents and children (ages 9 to 16; 1,420 participants) in rural North Carolina, with children followed up through young adulthood with almost 94% of them interviewed at least once up to age 30. By age 16, 23.9% (a weighted percentage) of children had an incarcerated parental figure, most commonly a biological father who was living outside the home. Parental incarceration was common and disproportionately so among African American and American Indian families. Study authors report parental incarceration was associated with childhood emotional and behavioral disorders and adversity in analyses that accounted for sex and race/ethnicity. In young adulthood (after accounting for childhood psychiatric diagnoses and adversity), parental incarceration was associated with an increased likelihood of having an anxiety disorder, an illicit drug use disorder, a felony charge, being incarcerated, not finishing high school, becoming a parent when younger than 18, and being socially isolated. Limitations of the study include that its sample of participants isn’t representative of the U.S. population and its observational design means the findings should be retested.

Authors: William E. Copeland, Ph.D., University of Vermont Medical Center, Burlington, and coauthors

(doi:10.1001/jamanetworkopen.2019.10005)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Is Greater PTSD Symptom Reduction in Veterans Associated With Lower Diabetes Risk?

Posted August 19, 2019 by Jim Michalski

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 21, 2019

Media advisory: To contact corresponding author Jeffrey F. Scherrer, Ph.D., email Maggie Rotermund at maggie.rotermund@slu.edu. The full study is linked to this news release.

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Bottom Line: This observational study examined whether veterans who experienced a greater reduction in symptoms of posttraumatic stress disorder (PTSD) had an associated lower risk of developing type 2 diabetes. PTSD is associated with an increased risk of type 2 diabetes, which may be partly explained by the greater likelihood of type 2 diabetes risk factors among individuals with PTSD. The analysis included medical records from nearly 1,600 veterans who received PTSD specialty care and had symptoms of PTSD assessed on a checklist questionnaire. Clinically meaningful improvement in PTSD symptoms constituted a greater score decrease on the checklist compared with less or no improvement in symptoms as reflected in a smaller score decrease during a 12-month period. During two to six years of follow-up, there were 105 new cases of type 2 diabetes, including new cases among 2.6% of veterans with a clinically meaningful improvement in symptoms and 5.9% of patients without that level of improvement. After accounting for factors that could influence the outcomes, patients with clinically meaningful improvement in symptoms were less likely to develop type 2 diabetes compared with those without such improvement. Limitations of the study include that the follow-up time was insufficient to conclude that improvement in PTSD symptoms is associated with a reduced lifetime risk of type 2 diabetes. The results also may not be generalizable to those who aren’t veterans.

Authors: Jeffrey F. Scherrer, Ph.D., of Saint Louis University School of Medicine and the Harry S. Truman Veterans Administration Medical Center, Columbia, Missouri, and coauthors.

(doi:10.1001/jamapsychiatry.2019.2096)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Study Analyzes Outcomes of Dual Antiplatelet Therapy After Minor Stroke or TIA

Posted August 15, 2019 by Deanna Bellandi

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 19, 2019

Media Advisory: The full study is linked to this news release.

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What The Study Did: An analysis of combined patient-level data from two randomized clinical trials examined outcomes of dual antiplatelet therapy with clopidogrel and aspirin after minor stroke or transient ischemic attack.

Authors: S. Claiborne Johnston, M.D., Ph.D., of the University of Texas at Austin, is the corresponding author.

(doi:10.1001/jamaneurol.2019.2531)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Is Childhood-Onset of IBD Associated With Risk of Psychiatric Disorders, Suicide Attempt?

Posted August 15, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 19, 2019

Media advisory: The full study and editorial are linked to this news release.

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What The Study Did: Data from Swedish national registers were used to examine the risk of psychiatric disorders and suicide attempt in individuals diagnosed as children with inflammatory bowel disease (IBD) compared with people in the general population and with siblings of patients with IBD.

Author: Agnieszka Butwicka, M.D., Ph.D., of the Karolinska Institutet in Stockholm, is the corresponding author.

(doi:10.1001/jamapediatrics.2019.2662)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Was Hospital Move to All Private Rooms Associated With Reductions in Health Care-Related Infections?

Posted August 15, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 19, 2019

Media advisory: The full study and commentary are linked to this news release.

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What The Study Did: A Montreal hospital moved from an older facility with ward-type rooms to a new facility with all private rooms and this analysis examined whether that was associated with reductions in multidrug-resistant organism colonization and health care-associated infections.

Authors: Todd C. Lee, M.D., M.P.H., of McGill University in Montreal, is the corresponding author.

(doi:10.1001/jamainternmed.2019.2798)

Editor’s Note: The article includes conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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How Many Years After Quitting Heavy Smoking Until Risk of Cardiovascular Disease Similar to Not Having Ever Smoked?

Posted August 15, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 20, 2019

Media advisory: To contact corresponding author Meredith S. Duncan, M.A., email Craig Boerner at craig.boerner@vumc.org. The full study and editor’s note are linked to this news release.

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Bottom Line: An analysis of Framingham Heart Study data examined the association of the time between quitting smoking and new cases of cardiovascular disease (CVD). This analysis included nearly 8,800 individuals, including 2,371 heavy smokers who smoked 20 or more pack-years, which is equal to smoking one pack of cigarettes daily for 20 years. Over an average follow-up of 26 years, 2,435 first CVD events (heart attack, stroke, heart failure or cardiovascular death) occurred in the entire group, with 1,095 among heavy smokers. The authors report quitting smoking was associated with lower risk of CVD within five years for former heavy smokers compared with current smokers but their risk remained higher for 10 to 15 years after cessation compared with people who never smoked. Limitations of the study include its smaller sample size compared to some previous studies, and participants in the study were primarily white individuals of European ancestry, potentially limiting the generalizability of the findings to others.

Authors: Meredith S. Duncan, M.A., Vanderbilt University Medical Center, Nashville, Tennessee, and coauthors

(doi:10.1001/jama.2019.10298)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Study Examines Maternal Exposure to Fluoride in Pregnancy, Kids’ IQ Scores

Posted August 15, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 19, 2019

Media advisory: To contact corresponding author Christine Till, Ph.D., email Anjum Nayyar at anayyar@yorku.ca. The full study, editorial, an editor’s note and a podcast are linked to this news release.

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Bottom Line: An observational study of 601 mother-child pairs from six cities in Canada hints at an apparent association between maternal exposure to fluoride during pregnancy and lower IQ scores measured in children ages 3 to 4. Community water has been fluoridated for decades to prevent tooth decay; a majority of U.S. residents are supplied with fluoridated water, as are more than one-third of Canadian residents and about 3% of European residents. This study analyzed two measures of fluoride exposure during pregnancy. Data on maternal urinary fluoride concentrations and children’s IQ were available for 512 mother-child pairs, and self-reported consumption of tap water and other water-based drinks (tea and coffee) and IQ scores were available for 400 of the 601 mother-child pairs. After accounting for factors associated with fluoride metabolism and children’s intellectual abilities, a 1-mg/L increase in maternal urinary fluoride was associated with a 4.5-point lower IQ score in boys without a statistically significant association with IQ score in girls. A 1-mg higher intake of fluoride was associated with a 3.7 lower IQ score among boys and girls. The study’s conclusions are limited by its observational design, which can’t account for unmeasured factors that could explain the results, and there was no assessment of children’s fluoride exposure during infancy. An accompanying podcast discusses the meaning and implications of the findings.

Author: Christine Till, Ph.D., of York University, Toronto, Canada, is the corresponding author.

(doi:10.1001/jamapediatrics.2019.1729)

Editor’s Note: The article contains conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Here’s a link to provide your readers free access to the full-text article

Posted August 13, 2019 by Jim Michalski

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Here’s a link to provide your readers free access to the full-text article

Posted August 13, 2019 by Jim Michalski

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USPSTF Recommendation on Screening, Genetic Counseling and Testing for BRCA-Related Cancer

Posted August 15, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 20, 2019

Media advisory: To contact the U.S. Preventive Services Task Force, email the Media Coordinator at Newsroom@USPSTF.net or call 202-572-2044. The full report, related articles and a podcast are linked to this news release.

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Bottom Line: The U.S. Preventive Services Task Force (USPSTF) is broadening its recommendation on screening for potentially harmful mutations of the breast cancer susceptibility BRCA1/2 genes, which are associated with increased risk of certain cancers. The USPSTF now recommends primary care clinicians assess risk in women with a personal or family history of breast, ovarian, fallopian tube, or peritoneal (tissue lining the abdominal cavity) cancer or those who have an ancestry associated with BRCA1/2 mutations. Women with a positive result on that risk assessment should receive genetic counseling and, if indicated after counseling, genetic testing. The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with BRCA1/2 mutations.

(doi:10.1001/jama.2019.10987)

Editor’s Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Note: More information about the U.S. Preventive Services Task Force, its process, and its recommendations can be found on the newsroom page of its website.

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For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Here’s a link to provide your readers free access to the full-text article

Posted August 12, 2019 by Jim Michalski

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Here’s a link to provide your readers free access to the full-text article

Posted August 12, 2019 by Jim Michalski

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Here’s a link to provide your readers free access to the full-text article

Posted August 12, 2019 by Jim Michalski

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Here’s a link to provide your readers free access to the full-text article

Posted August 12, 2019 by Jim Michalski

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How Common is Nearsightedness Among Schoolchildren in Japan?

Posted August 13, 2019 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 15, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This study of 1,400 elementary and junior high school students in Tokyo estimated the rate of nearsightedness.

Authors: Toshihide Kurihara, M.D., Ph.D., and Kazuo Tsubota, M.D., Ph.D., of the Keio University School of Medicine in Tokyo, are the corresponding authors.

(doi:10.1001/jamaophthalmol.2019.3103)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Feasibility of Antimicrobial Stewardship Interventions in Community Hospitals

Posted August 13, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 16, 2019

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

What The Study Did: This study evaluated whether implementing two antimicrobial stewardship interventions (pharmacist approval to continue antibiotic use after the first dose and pharmacist engagement with the prescriber about antibiotic appropriateness after 72 hours of treatment) were feasible in community hospitals.

Authors: Deverick J. Anderson, M.D., M.P.H., of the Duke University School of Medicine in Durham, North Carolina, is the corresponding author.

(doi:10.1001/jamanetworkopen.2019.9369)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Differences in End-of-Life Interventions Between Men, Women With Advanced Dementia

Posted August 13, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 16, 2019

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

What The Study Did: In a study of 27,000 nursing home residents in Canada with advanced dementia who died, researchers describe differences between men and women in receiving burdensome interventions in the last 30 days of life (including invasive procedures and physical restraints) and antibiotic therapy.

Authors: Paula A. Rochon, M.D., M.P.H., of the Women’s College Hospital in Toronto, is the corresponding author.

(doi:10.1001/jamanetworkopen.2019.9557)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Firearm Storage Practices Among Military Personnel With Suicidal Thoughts

Posted August 13, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 16, 2019

Media advisory: To contact corresponding author Craig J. Bryan, Psy.D., A.B.P.P., email Julie Kiefer at julie.kiefer@hsc.utah.edu. The full study and podcast are linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: This observational study analyzed survey data from 1,652 active-duty military personnel to examine associations between firearm ownership and storage practices with suicidal thoughts and behaviors. More than one-third (35.7%) of military personnel reported having a firearm in or around their homes, with 32.2% indicating their firearms were safely stored unloaded and locked up. Study authors report that although service members with recent thoughts about death or self-harm were less likely to report having firearms at home, safe storage practices were less common among those with a history of suicidal thoughts or behaviors who had firearms. Limitations of the study include self-reported information.

Authors: Craig J. Bryan, Psy.D., A.B.P.P., University of Utah, Salt Lake City, and coauthors

(doi:10.1001/jamanetworkopen.2019.9160)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Is Blood Pressure Measured Outside of Clinic Associated with Cardiovascular Disease in African Americans?

Posted August 12, 2019 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 14, 2019

Media advisory: To contact corresponding author Yuichiro Yano, M.D., Ph.D., email Sarah Avery at sarah.avery@duke.edu. The full study is linked to this news release.

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Bottom Line: This observational study examined whether daytime and nighttime blood pressure (BP) levels measured outside a clinical setting are associated with cardiovascular disease (CVD) and risk of death. Blood pressure levels measured at a clinic may not accurately reflect levels that a person experiences at home, work or while asleep. Using data from the Jackson Heart Study, which is designed to identify CVD risk factors among African American individuals, this analysis included 1,034 adults who had average daytime and nighttime BP levels calculated based on measurements from a BP monitor on their arm that took readings every 20 minutes during a 24-hour period. During follow-up there were 113 CVD events (including coronary heart disease and stroke) and 194 deaths. The authors report that individuals with higher levels of daytime and nighttime systolic BP had an associated increased risk for CVD events and death, independent of BP levels measured in the clinic. The increase in CVD risk was larger among participants not taking BP medication. The findings suggest monitoring daytime and nighttime BP outside the clinic during a 24-hour period may help to identify African Americans at increased risk for CVD. A limitation of the study to consider is that 24-hour BP monitoring was performed only once among participants, and the researchers were unable to assess whether changes in daytime and nighttime BP during follow-up were associated with outcomes.

Authors: Yuichiro Yano, M.D., Ph.D., Duke University, Durham, North Carolina, and coauthors.

(doi:10.1001/jamacardio.2019.2845)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Age Distribution of New Obesity-Associated Cancer Cases

Posted August 12, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 14, 2019

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

What The Study Did: This observational study examines changes in the age distribution of new obesity-associated cancer cases and nonobesity-associated cancer cases from 2000 to 2016 by sex and race/ethnicity.

Authors: Siran M. Koroukian, Ph.D., of Case Western Reserve University School of Medicine in Cleveland, is the corresponding author.

(doi:10.1001/jamanetworkopen.2019.9261)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Are Refugees at Increased Risk of Developing Mental Disorders?

Posted August 12, 2019 by Jim Michalski

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 14, 2019

Media advisory: To contact corresponding author Jonathan Henssler, M.D., email jonathan.henssler@charite.de. The full study and editorial are linked to this news release.

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Bottom Line: Whether the experience of being a refugee increases the probability of developing a mental disorder such as schizophrenia was the focus of this study, a systematic review and meta-analysis that combined the results of nine studies involving 540,000 refugees in Denmark, Sweden, Norway and Canada. The relative risk of refugees developing nonaffective psychosis (which includes several mental disorders such as schizophrenia) was compared with the risk of natives of the host country and nonrefugee migrants there. Study authors report the refugee experience may be a risk factor in nonaffective psychosis in migrants. Limitations of the research include that with the exception of Canada, the studies included in the analysis were all from Scandinavian countries, which may limit the generalizability of the findings to other countries.

Authors: Lasse Brandt, M.D. and Jonathan Henssler, M.D., Charité University Medicine Berlin, Germany, and coauthors

(doi:10.1001/jamapsychiatry.2019.1937)

Editor’s Note: The article includes conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Doctors Help Parents Talk With Teens About Sex, Alcohol

Posted August 13, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 16, 2019

Media advisory: To contact corresponding author Carol A. Ford, M.D., email Joey McCool Ryan at MCCOOL@email.chop.edu. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Parents and teens find it difficult to talk about sex and alcohol, and this study finds that doctors can help. This randomized clinical trial evaluated whether interventions targeted at parents in primary care pediatric settings might improve communications between parents and their teens about sexual health and alcohol use. The interventions were selected because in previous research outside of clinic settings they have been shown to encourage teens to wait until they’re older to have sex, use protection if they do have sex, and reduce alcohol use. The study included 118 parent-adolescent pairs, with 38 pairs in a sexual health intervention, 40 pairs in an alcohol prevention intervention, and 40 pairs in a control group for comparison who received usual care. Parents in the interventions received coaching on key messages regarding sexual health and alcohol and were encouraged to engage in parent-adolescent communication about it within two weeks, at which time there was a follow-up call to parents from health coaches. Participants were surveyed four months later and study authors report an increased frequency of parent-teen communications about sexual health and alcohol use in the intervention groups compared to the control group. Results suggest that doctors have an opportunity to help parents and teens communicate about sex and alcohol in ways that will help young people make healthier choices about sexual behaviors and alcohol use. Limitations of the study include that it was conducted at a single site and parent-teen communications were self-reported.

Authors: Carol A. Ford, M.D., Children’s Hospital of Philadelphia, and coauthors

(doi:10.1001/jamanetworkopen.2019.9535)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Posted August 12, 2019 by Deanna Bellandi

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Cannabis-Related Poison Control Cases in Kids, Teens in Massachusetts Around Medical Marijuana Legalization

Posted August 13, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 16, 2019

Media advisory: To contact corresponding author Jennifer M. Whitehill, Ph.D., email Patty Shillington at pshillington@umass.edu. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: Rates of marijuana exposure cases in children and teens reported to a poison control center increased after Massachusetts legalized medical marijuana in 2012. From 2009 to 2016, there were 218 cannabis-related calls (a small portion of the calls to the poison center) about exposure in children and teens to age 19, with most of the calls coming from health care facilities. Teens ages 15 to 19 were involved in the highest number of cases followed by children to age 4. Exposures among teenagers were mostly classified as intentional whereas exposures among young children were unintentional. There were statistically significant increases in the number of exposures to edible products in both of these age groups. The rate for all cases involving cannabis for the four years before and the four years after medical marijuana legalization increased from 1.3 to 2.2 per 100,000. Limitations of the study include the small number of calls and self-reported marijuana exposures that may not have been verified by laboratory testing.

Authors: Jennifer M. Whitehill, Ph.D., University of Massachusetts Amherst, and coauthors

(doi:10.1001/jamanetworkopen.2019.9456)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Blood Pressure Patterns in Middle-Age, Older Adults Associated With Dementia Risk

Posted August 8, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 13, 2019

Media advisory: To contact corresponding author Keenan A. Walker, Ph.D., email Vanessa McMains at vmcmain1@jhmi.edu. The full study, editorial, related article and video are linked to this news release. The summary video can be viewed on this page and embedded on your website by copying and pasting the HTML code below.

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Bottom Line: Patterns of high blood pressure in midlife that extend to late life or high blood pressure in midlife followed by low blood pressure later in life was associated with increased risk for dementia compared to having normal blood pressure. This observational study included nearly 4,800 participants who had blood pressure measurements taken over 24 years at five visits plus a detailed neurocognitive evaluation during the fifth and a sixth visit, where dementia was assessed. There were 516 new cases of dementia diagnosed between the fifth and sixth visits. Study authors report that compared with maintaining normal blood pressure, an increased risk of dementia was associated with hypertension (greater than 140/90 mm Hg or use of antihypertensive medication) in midlife (age 54 to 63) that was sustained to late life and a pattern of hypertension in midlife and low blood pressure (less than 90/60 mm Hg) later life. Midlife hypertension followed by late-life low blood pressure also was associated with increased risk of mild cognitive impairment. Limitations of the study include that the findings may have been biased because of the increased likelihood that participants with higher blood pressure and poorer cognition during midlife dropped out of the study. Also, study participants were from Washington County, Maryland; Forsyth County, North Carolina; Jackson, Mississippi; and Minneapolis, so the results may not be generalizable to other areas.

Authors: Keenan A. Walker, Ph.D., Johns Hopkins University School of Medicine, Baltimore, and coauthors

(doi:10.1001/jama.2019.10575)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Exposure to Outdoor Air Pollutants, Change in Emphysema, Lung Function

Posted August 8, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 13, 2019

Media advisory: To contact corresponding author Joel D. Kaufman, M.D., M.P.H., email Jackson Holtz at jjholtz@uw.edu. The full study and video are linked to this news release. The summary video can be viewed on this page and embedded on your website by copying and pasting the HTML code below.

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Bottom Line: Whether exposure to outdoor air pollutants is associated with emphysema progression and change in lung function was the focus of this observational study. The study included 7,071 participants from the Multi-Ethnic Study of Atherosclerosis studies conducted in six U.S. metropolitan regions (New York; Los Angeles; Chicago; Baltimore; Winston-Salem, North Carolina; and St. Paul, Minnesota). Computed tomographic (CT) scans were used to assess changes in emphysema (measured for density as a percentage of lung pixels) and lung function testing was done. Levels of outdoor air pollutants (ozone, fine particulate matter, oxides of nitrogen and black carbon) at each participant’s home were estimated. Study authors report exposure to ambient air pollutants, especially ozone, was associated with increasing emphysema progression based on up to five repeated CT scans over 10 years. Ambient ozone exposure, but not the other pollutants, also was associated with decline in lung function. Limitations of the study include that outdoor air pollutant concentrations may not reflect everything about an individual’s air pollutant exposures, and outdoor concentrations don’t explain all of the variations in concentrations of pollutants indoors, where most people spend the majority of their time.

Authors: Joel D. Kaufman, M.D., M.P.H., University of Washington, Seattle, and coauthors

(doi:10.1001/jama.2019.10255)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Posted August 6, 2019 by Deanna Bellandi

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Posted August 6, 2019 by Deanna Bellandi

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Posted August 6, 2019 by Deanna Bellandi

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Posted August 6, 2019 by Deanna Bellandi

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Posted August 6, 2019 by Deanna Bellandi

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Likelihood of Marijuana Use Among Young People Who Used e-Cigarettes

Posted August 8, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 12, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This study (called a systematic review and meta-analysis) combined the results of 21 studies with about 128,000 participants to quantify the association between electronic cigarette use and marijuana use among adolescents and young adults.

Author: Nicholas Chadi, M.D., M.P.H., of Boston Children’s Hospital and Harvard Medical School in Boston, is the corresponding author.

(doi:10.1001/jamapediatrics.2019.2574)

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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Is Intensive Blood Pressure Control Associated With Less Progression of Brain Vascular Disease?

Posted August 8, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 13, 2019

Media advisory: To contact corresponding author R. Nick Bryan, M.D., Ph.D., email Shahreen Abedin at Shahreen.Abedin@austin.utexas.edu. The full study, editorial, related article and video are linked to this news release. The summary video can be viewed on this page and embedded on your website by copying and pasting the HTML code below.

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Bottom Line: Intensive blood pressure control among adults with high blood pressure was associated with a smaller increase in brain white matter lesions (a marker of small vessel disease and a risk factor for dementia) compared to standard blood pressure control, although the difference was small. Hypertension is a risk factor for developing white matter lesions. This analysis is a substudy of a randomized clinical of 449 patients with high blood pressure who had initial brain magnetic resonance imaging (MRI) and a follow-up MRI after four years. Researchers report intensive systolic blood pressure control (goal of less than 120 mm Hg) was associated with a smaller increase in white matter lesion volume compared with standard treatment (goal of less than 140 mm Hg). There also was a greater decrease in total brain volume, although the difference was small and the significance of this finding is unclear. Limitations of the study include the relatively short duration of the intervention and follow-up. Given the limited size of this study, it’s also not possible to correlate changes in brain structure with dementia occurrence.

Authors: R. Nick Bryan, M.D., Ph.D., University of Texas at Austin, and coauthors

(doi:10.1001/jama.2019.10551)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Study Examines Gluten Consumption in Childhood, Celiac Disease Risk in Genetically At-Risk Kids

Posted August 8, 2019 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 13, 2019

Media advisory: To contact corresponding author Daniel Agardh, M.D., Ph.D., email daniel.agardh@med.lu.se. The full study and editorial are linked to this news release.

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Bottom Line: Consuming more gluten during the first five years of life was associated with increased risk of celiac disease and celiac disease autoimmunity (the presence of antibodies in the blood) among genetically predisposed children. It remains unclear whether the amount of gluten consumed can trigger celiac disease. This observational study included 6,605 children born between 2004 and 2010 in Finland, Germany, Sweden and the United States who had a genetic predisposition for celiac disease. Gluten intake was estimated from food records collected at ages 6, 9, and 12 months and then biannually until the age of 5. Of the 6,605 children, 18% developed celiac disease autoimmunity and 7% developed celiac disease. The incidence of both outcomes peaked at 2 to 3 years old. The authors report that for every 1-gram per day increase in gluten consumption there was an associated higher risk of celiac disease and celiac disease autoimmunity. If gluten intake was one gram per day higher than the average at age 2 (corresponding to a half slice of white bread), the absolute risk differences for celiac disease autoimmunity and celiac disease were 6% and 7% higher, respectively, by age 3. A limitation of the study is the uncertainty of the accuracy of the reported gluten intake. The authors suggest a randomized clinical trial be done of different amounts of gluten during early childhood in genetically at-risk children.

Authors: Daniel Agardh, M.D., Ph.D., Lund University, Malmo, Sweden and coauthors

(doi:10.1001/jama.2019.10329)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Analysis of Out-of-Network Billing of Privately Insured Patients at In-Network Hospitals

Posted August 8, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 12, 2019

Media advisory: To contact corresponding author Eric Sun, M.D., Ph.D., email Beth Duff-Brown at bethduff@stanford.edu. The full study, editorial and viewpoint are linked to this news release.

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Bottom Line: An analysis of claims data for privately insured patients suggests out-of-network billing for inpatient admissions and emergency department (ED) visits to in-network hospitals has increased along with the patient financial liability associated with it. This study included 5.4 million inpatient admissions and nearly 13.6 million ED visits to in-network hospitals between 2010-2016. Of all the ED visits, 39.1% generated an out-of-network bill and 37% of all the inpatient admissions resulted in an out-of-network bill. The percentage of ED visits with an out-of-network bill increased from 32.3% to 42.8% during the study period and the percentage of inpatient admissions with an out-of-network bill increased from 26.3% to 42% during that same time. The potential patient financial responsibility associated with out-of-network bills increased too, from an average $220 to $628 for ED visits and from an average $804 to $2,040 for inpatient admissions. A common example of out-of-network billing was ambulance transport. This study has some limitations, including no information on what patients actually paid to settle out-of-network bills. Researchers suggest their findings support strengthening legislative protections against the surprise medical bills associated with out-of-network billing.

Authors: Eric Sun, M.D., Ph.D., of Stanford University Medical Center in Stanford, California, is the corresponding author.

(doi:10.1001/jamainternmed.2019.3451)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Posted August 5, 2019 by Deanna Bellandi

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Extreme Heat Associated With Increased Risk of Hospitalization, Death for Patients With ESRD

Posted August 6, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 9, 2019

Media advisory: To contact corresponding author Amir Sapkota, Ph.D., email Bem Faris at bfaris@umd.edu. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: This observational study looked at whether extreme heat is associated with increased risk of hospitalization or death among the vulnerable population of patients with end-stage renal disease (ESRD). The study included 7,445 patients with ESRD who underwent long-term hemodialysis treatment at clinics in Boston, Philadelphia or New York from 2001 to 2012. During that time, 2,953 of the patients died. Researchers used historical weather data to identify extreme heat days and investigated if exposures to such extreme heat days increased risk of hospitalizations and deaths among the patients. Extreme heat was associated with increased risk of same-day hospital admission and same-day death, with the risk of death greater among patients living with congestive heart failure, chronic obstructive pulmonary disease or diabetes. Risk varied between cities and by race/ethnicity. Limitations of the study include a lack of data to verify indoor conditions for patients and the study didn’t account for multiple-day heat waves, which could present a more severe threat for patients with ESRD.

Authors: Amir Sapkota, Ph.D., University of Maryland School of Public Health, College Park, and coauthors

(doi:10.1001/jamanetworkopen.2019.8904)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Analysis of Medical Aid in Dying in Oregon, Washington

Posted August 6, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 9, 2019

Media advisory: To contact corresponding author Charles D. Blanke, M.D., email Wendy Lawton at lawtonw@ohsu.edu. The full study and commentary are linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: An examination of a combined 28 years of data finds similarities in the characteristics and illnesses of patients requesting medical aid in dying in Oregon and Washington. The study included 3,368 prescriptions written for medical aid in dying, with 2,558 patients dying by lethal ingestion of medication, in the two states from 1998 to 2017 in Oregon and from 2009 to 2017 in Washington. Most of the patients were insured, non-Hispanic white individuals with some level of college education, 65 or older, and diagnosed with cancer. Loss of autonomy, impaired quality of life and loss of dignity were the most common reasons for pursuing medical aid in dying. Limitations of the study include physicians, not patients, providing the underlying reasons for requesting medical aid in dying as part of a follow-up questionnaire.

Authors: Charles D. Blanke, M.D., Oregon Health & Science University, Portland, and coauthors

(doi:10.1001/jamanetworkopen.2019.8648)

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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For more information, contact JAMA Network Media Relations at 312-464-JAMA (5262) or email mediarelations@jamanetwork.org.

Tech-Enhanced Intervention Tested for Female Adolescents, Young Adults With Pelvic Inflammatory Disease

Posted August 5, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 7, 2019

Media advisory: The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

What The Study Did: This randomized clinical trial compared a technology-enhanced community health nursing intervention that included text message medication reminders with standard care for female adolescents and young adults with pelvic inflammatory disease.

Authors: Maria Trent, M.D., M.P.H., of the Johns Hopkins University School of Medicine in Baltimore, is the corresponding author.

(doi:10.1001/jamanetworkopen.2019.8652)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Analysis of Sex Disparities in Ophthalmic Research

Posted August 13, 2019 by Deanna Bellandi

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 15, 2019

Media advisory: The full study and commentary are linked to this news release.

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What The Study Did: Sex disparities in ophthalmic research were analyzed in this study that evaluated the representation of female authorships in ophthalmologic journals from 2008 to 2018, with sex assigned according to first name.

Authors: Michael H. K. Bendels, M.D., Ph.D., of Goethe-University in Frankfurt, Germany, is the corresponding author.

(doi:10.1001/jamaophthalmol.2019.3095)

Editor’s Note: The article contains conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Opioid Prescribing Patterns in Children After Tonsillectomy

Posted August 6, 2019 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 8, 2019

Media advisory: To contact corresponding author Kao-Ping Chua, M.D., Ph.D., email Beata Mostafavi at bmostafa@med.umich.edu. The full study is linked to this news release.

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Bottom Line: National private insurance claims data were used to examine opioid prescribing patterns in children after tonsillectomy and return visits for complications. Opioids are commonly used after tonsillectomy, although American Academy of Otolaryngology clinical practice guidelines recommend nonopioids such as NSAIDs. This analysis included 2016 and 2017 claims data coded for tonsillectomy for nearly 16,000 children; nearly 60 percent of whom had one or more prescription drug claims for opioids between seven days before to one day after tonsillectomy. Having one or more prescription fills wasn’t associated with return visits for pain or dehydration or bleeding compared with children not using opioids but it was associated with increased risk of return visits for constipation. The study authors suggest reducing opioid prescribing to children after tonsillectomy may be possible without increasing risk of complications. The study has several limitations, including that children may not use opioids even when prescriptions are filled.

Authors: Kao-Ping Chua, M.D., Ph.D., University of Michigan, Ann Arbor, and coauthors

(doi:10.1001/jamaoto.2019.2107)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Is Giant Cell Arteritis Associated With Race?

Posted August 6, 2019 by Deanna Bellandi

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 8, 2019

Media advisory: The full study and commentary are linked to this news release.

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What The Study Did: Giant cell arteritis is an inflammation of the blood vessels that typically occurs in adults over 50 and, if left untreated, can result in irreversible vision loss and death. This study examined whether occurrence of the disorder was associated with race.

Authors: Anna M. Gruener, B.M.B.S., M.Sc., F.R.C.Ophth, of the Nottingham University Hospitals National Health Service Trust in the United Kingdom, is the corresponding author.

(doi:10.1001/jamaophthalmol.2019.2919)

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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Do Internal Medicine Residents Feel Bullied During Training?

Posted August 8, 2019 by Deanna Bellandi

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 13, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This research letter uses survey data to report on perceived bullying by internal medicine residents during training.

Authors: Scott M. Wright, M.D., of the Johns Hopkins Bayview Medical Center in Baltimore, is the corresponding author.

(doi:10.1001/jama.2019.8616)

Editor’s Note: The article contains funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Note: More information about the U.S. Preventive Services Task Force, its process, and its recommendations can be found on the newsroom page of its website.

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Association of Coexisting Psychiatric Disorders, Risk of Death in Patients With ADHD

Posted August 5, 2019 by Jim Michalski

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 7, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This observational study of Swedish national register data included nearly 87,000 people with attention-deficit/hyperactivity disorder (ADHD) and examined the association of coexisting psychiatric disorders with risk of death.

Authors: Shihua Sun, M.D., of the Karolinska Institutet in Stockholm, Sweden, is the corresponding author.

(doi:10.1001/jamapsychiatry.2019.1944)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Study in Taiwan Examines Association of ADHD, Causes of Death

Posted August 5, 2019 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 7, 2019

Media advisory: To contact corresponding author Charles Tzu-Chi Lee, Ph.D., email lee@ntnu.edu.tw. The full study is linked to this news release.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Wednesday and Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

Bottom Line: A nationwide population-based study in Taiwan suggests attention-deficit/hyperactivity disorder (ADHD) may be associated with a higher risk of death from injury causes, including suicide, unintentional injury and homicide. Although the risk of suicide-related death was higher in patients with ADHD than in those without, the absolute risk of death was low and suicide deaths were rare, with natural-cause deaths and unintentional injury deaths accounting for a higher number of deaths than suicide in the group of patients with ADHD. This observational study used registry data and included nearly 276,000 patients (ranging in age from 4 to 44) first diagnosed with ADHD between 2000 and 2012 and nearly 2 million individuals without ADHD for comparison. There was no increased risk of natural-cause death between the two groups. More research is needed to understand the causes of injury deaths in patients with ADHD and identify ways to mitigate them. Limitations of the study include the findings may not generalizable to others, including people with ADHD who aren’t diagnosed and those in other international settings. The study also couldn’t analyze the effects of ADHD medications and other potential mitigating factors, such as family history and psychosocial stress.

Authors: Charles Tzu-Chi Lee, Ph.D., National Taiwan Normal University, Taipei, and coauthors

(doi:10.1001/jamanetworkopen.2019.8714)

Editor’s Note: The article includes conflict of interest and funding/support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Overweight, Obesity in Children Across Europe

Posted August 1, 2019 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 5, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: This study (called a systematic review and meta-analysis) combined the results of 103 studies with nearly 478,000 children (ages 2 to 13) to look at how common overweight and obesity are among children across Europe.

Author: Iván Cavero-Redondo, Ph.D., of the Universidad de Castilla-La Mancha, in Cuenca, Spain, is the corresponding author.

(doi:10.1001/jamapediatrics.2019.2430)

Editor’s Note: The article contains conflict of interest disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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Industry Payments to Physician Director of NCI-Designated Cancer Centers

Posted August 1, 2019 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 5, 2019

Media advisory: The full study is linked to this news release.

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What The Study Did: Data from the Centers for Medicare & Medicaid Services were used to examine industry payments to physician directors of National Cancer Institute-designated cancer centers in this research letter.

Authors: David Carr, M.D., of the University of California, San Diego, is the corresponding author.

(doi:10.1001/jamainternmed.2019.3098)

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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