How Common Are Traumatic Brain Injuries in Children?

Posted September 20, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 24, 2018

Media advisory: To contact corresponding author Juliet Haarbauer-Krupa, Ph.D., email Courtney Lenard at zvq5@cdc.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.2740

Bottom Line: An estimated 2.5 percent of U.S. children have experienced traumatic brain injury (TBI) during their lifetime based on reports from parents in an analysis of national survey data.

Why The Research Is Interesting: TBI in children is a public health concern because such injuries send children to emergency departments and carry risk for long-term adverse outcomes. This study analyzed national survey data to estimate how common it is for children to have a TBI during their lifetime based on reports from parents of a concussion or brain injury diagnosed by a health care professional.

Who, What and When: An analysis of data from the 2011-2012 National Survey of Children’s Health to estimate lifetime TBI in children, associated childhood health conditions, and health insurance type and adequacy based on reports from parents

How (Study Design): This was a data analysis.

Authors: Juliet Haarbauer-Krupa, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors.

Results:

Study Limitations: The study didn’t examine medical records and relies on parents reporting diagnoses.

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.2740)

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.

Health Data Breaches on the Rise

Posted September 20, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 25, 2018

Media advisory: To contact corresponding author Thomas H. McCoy Jr., M.D., email Noah Brown at nbrown9@partners.org. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.9222

Bottom Line: The ongoing transition to electronic health records may increase data breaches involving patient records. An analysis of reported breaches of health data from 2010 through 2017 found that except for 2015, the number of breach reports increased each year. During this time there were 2,149 breaches comprising a total of 176.4 million records. The most common entity breached was a health care provider, with 1,503 breaches (70 percent) compromising a total of 37.1million records. Health plans accounted for the largest share of breached records (110.4 million). There was an increasing number of breaches associated with health care providers over time. The greatest numbers of records breached were accessed via network-connected information. A limitation of the study is that the results describe trends but do not allow for inferences about the causes of those trends.

Authors: Thomas H. McCoy Jr., M.D., and Roy H. Perlis, M.D., M.Sc., Massachusetts General Hospital, Boston, and Associate Editor, JAMA Network Open (Dr. Perlis)

Related Material

Previously published by JAMA:

Data Breaches of Protected Health Information in the United States

Keeping Personal Health Information Safe

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.9222)

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.

JAMA Network Retracts 6 Articles That Included Dr. Brian Wansink as Author

Posted September 19, 2018 by Deanna Bellandi

FOR IMMEDIATE RELEASE: SEPTEMBER 19, 2018

Media advisory: To contact JAMA Network Media Relations email mediarelations@jamanetwork.org.

CHICAGO – JAMA, JAMA Internal Medicine and JAMA Pediatrics have retracted six articles that included Brian Wansink, Ph.D., of Cornell University, Ithaca, New York, as author. Below is the notice of retraction published online today by JAMA, which references the retracted articles (see references 4-9). Similar notices were published online today in JAMA Internal Medicine and JAMA Pediatrics.

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

Is Survival Associated With Time to Defibrillation for In-Hospital Cardiac Arrest in Pediatric Patients?

Posted September 18, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 21, 2018

Media advisory: To contact corresponding study author Elizabeth A. Hunt, M.D., M.P.H., Ph.D., email Chanapa Tantibanchachai at chanapa@jhmi.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.2643

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: The time until a first attempt at defibrillation in pediatric patients who experienced cardiac arrest in the hospital wasn’t associated with survival or other main outcomes. This is in contrast to children who have a cardiac arrest outside of the hospital setting, or adult patients in or out of the hospital, where worse outcomes are associated with defibrillation delayed more than two minutes.

Why The Research Is Interesting: About 6,000 children each year in the United States experience cardiac arrest while in the hospital. In adults, delayed defibrillation attempts of more than two minutes are a national quality measure.

Who and When: Data for 477 pediatric patients younger than 18 from 113 hospitals with an in-hospital cardiac arrest, a documented loss of pulse and least one defibrillation attempt from 2000 to 2015.

What (Study Measures and Outcomes): Time between loss of pulse and first defibrillation attempt (exposure); survival to hospital discharge (primary outcome); return of circulation, 24-hour survival, and favorable neurologic outcome at hospital discharge (secondary outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Elizabeth A. Hunt, M.D., M.P.H., Ph.D., of Johns Hopkins Charlotte Bloomberg Children’s Center, Baltimore, Maryland, and co-authors

Results: Most pediatric patients (71 percent) had a first attempt at defibrillation within two minutes of loss of pulse. There was no difference associated with survival in pediatric patients with a first defibrillation attempt in two minutes or less compared with more than two minutes; time to the first defibrillation attempt also wasn’t associated with the other outcomes. The authors offer several possibilities to explain their results.

Study Limitations: The sample size; that most first defibrillation attempts were within two minutes of loss of pulse; and that the sudden nature of cardiac arrest may have led to some misclassification of time and other variables.

Study Conclusions:

Related Material: The invited commentary, “Shorter Time to Defibrillation in Pediatric CPR — Children Are Not Small Adults But Shock Them Like They Are,” by Alexis Topjian, M.D., M.S.C.E., of the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.2643)

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

Do Rates of Burnout, Career-Choice Regret Vary by Specialty Among Resident Physicians?

Posted September 13, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 18, 2018

Media advisory: To contact corresponding author Liselotte N. Dyrbye, M.D., M.H.P.E., email Robert Nellis at newsbureau@mayo.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.12615

Bottom Line: Burnout is common among physicians. But do rates of burnout symptoms and career-choice regret vary among physicians in training by clinical specialty? In a study of nearly 3,600 second-year residents who were followed-up with questionnaires since medical school, 45 percent reported burnout symptoms and 14 percent reported regret over their career choice. The frequency of burnout symptoms and career-choice regret varied widely by specialty. Residents who trained in urology, neurology, emergency medicine or general surgery were more likely to report burnout symptoms compared with residents training in internal medicine, while residents who trained in pathology and anesthesiology were more likely to report career regret. Limitations of this observational study include that study participants may not be representative of all U.S. resident physicians. Regardless of specialty, high levels of anxiety and low levels of empathy reported during medical school were associated with burnout symptoms during residency.

Authors: Liselotte N. Dyrbye, M.D., M.H.P.E., Mayo Clinic, Rochester, Minnesota and coauthors

Related Material

The following related elements from The JAMA Network are also available on the For The Media website:

— The JAMA study, “Prevalence of Burnout Among Physicians.”

— The JAMA editorial, “Physician Burnout—A Serious Symptom, But of What?”

Previously published:

— From JAMA Surgery, “Multiple-Institution Comparison of Resident and Faculty Perceptions of Burnout and Depression During Surgical Training.”

— From JAMA Internal Medicine, “Workplace Factors Associated With Burnout of Family Physicians.”

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.12615)

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.

Helping Parents Decide on Care for Children with Minor Head Trauma

Posted September 18, 2018 by Jim Michalski

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 21, 2018

Media advisory: To contact study author Erik P. Hess, M.D., M.Sc., email Bob Shepard at bshep@uab.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.2430

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: More than 450,000 children visit emergency departments every year because of head trauma and many will undergo head computed tomography (CT) imaging, although few scans will show evidence of traumatic brain injury. Efforts have been made to avoid unnecessary CT imaging in children and to reduce radiation exposure. An information tool to help parents decide about care for their children with minor head trauma didn’t reduce the rate of CT imaging in emergency departments in this randomized clinical trial. However, parent knowledge increased, they were more involved in decisions over CT use, and health care utilization decreased during the following week.

Authors: Erik P. Hess, M.D., M.Sc., University of Alabama at Birmingham, and coauthors

Related Material: The invited commentary, “Shared Decision-Making Tools in Pediatric Acute Care,” by M. Denise Dowd, M.D., M.P.H., Children’s Mercy Hospital, Kansas City, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.2430)

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 emailmediarelations@jamanetwork.org.

Cannabis Use in E-Cigarettes by U.S. Youth

Posted September 13, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 17, 2018

Media advisory: To contact corresponding author Katrina F. Trivers, Ph.D., M.S.P.H., email Joel London at jlondon@cdc.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.1920

Bottom Line: An analysis of survey data estimates nearly 1 in 11 U.S. middle and high school students used cannabis in electronic-cigarettes in 2016. Among e-cigarette users, nearly 1 in 3 high school students and nearly 1 in 4 middle school students reported having ever used cannabis in e-cigarettes. Data were from a 2016 survey of students in the 6th through 12th grades which used a nationally representative sample of students in public and private schools. Researchers note their estimates were consistent with or higher than previous study reports, and that comparability between studies could be limited by differences in survey question wording. Researchers suggest their findings reinforce the importance of strategies to reduce cannabis use in e-cigarettes.

Authors: Katrina F. Trivers, Ph.D., M.S.P.H., of the Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.1920)

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.

Updated Estimates of Frequency of Adverse Childhood Experiences

Posted September 13, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 17, 2018

Media advisory: To contact corresponding author Melissa T. Merrick, Ph.D., email Courtney Lenard at zvq5@cdc.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.2537

Bottom Line: A new survey study suggests childhood adversity is common across sociodemographic groups but that some people are at higher risk of having experienced childhood adversity. The study updates the estimated frequency of adverse childhood experiences in the U.S. adult population using a representative sample of people from 23 states. Findings suggest people who identified as black, Hispanic or multiracial, had less than a high school education, less than a $15,000 annual income, were unemployed or unable to work, and identified as gay/lesbian or bisexual reported higher exposure to adverse childhood experiences than other groups. The most common adverse childhood experiences were emotional abuse, parental separation or divorce, and household substance abuse. Prevention of adverse childhood experiences can improve health and life outcomes.

Authors: Melissa T. Merrick, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.2537)

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.

Small Study Evaluates Use of Medical Scribes in Primary Care

Posted September 13, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 17, 2018

Media advisory: To contact corresponding author Pranita Mishra, M.P.P., email Janet Byron at Janet.L.Byron@kp.org. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.3956

Bottom Line: Medical scribes transcribe information during clinical visits in real time into electronic health records (EHRs) under physician supervision. A small study of 18 primary care physicians evaluated the association of using medical scribes with physician workflow and patient experience.

Authors: Pranita Mishra, M.P.P., of Kaiser Permanente Northern California, Oakland, California, and coauthors

Related Material: The invited commentary, “Use of Medical Scribes to Reduce Documentation Burden: Are They Where We Need to Go With Clinical Documentation,” by David W. Bates, M.D., M.Sc., and Adam B. Landman, M.D., of Brigham and Women’s Hospital, Boston, Massachusetts, and coauthors also is available.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.3956)

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 emailmediarelations@jamanetwork.org.

USPSTF Recommendation Statement on Behavioral Weight Loss Interventions to Prevent Obesity-Related Health Problems, Death in Adults

Posted September 13, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 18, 2018

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 is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time and all links to all USPSTF articles remain free indefinitely: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.13022

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians offer or refer adults with a body mass index of 30 or higher to intensive behavioral interventions that focus on dietary changes and increased physical activity and that provide a variety of components to support weight loss and to maintain it.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement is an update of its 2012 recommendation on screening for obesity in adults. More than 35 percent of men and 40 percent of women in the United States are obese. Obesity is associated with health problems such as increased risk for coronary heart disease, type 2 diabetes. various types of cancer and disability. Obesity is also associated with an increased risk for death, particularly among adults younger than 65 years.

The USPSTF Concludes:

Related Material

The following related elements from The JAMA Network are also available on the For The Media website:

Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults – U.S. Preventive Services Task Force Recommendation Statement

Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults – Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

JAMA editorial: Weight Management in Adults With Obesity

JAMA Internal Medicine editorial: Treating Obesity – Moving From Recommendation to Implementation

JAMA Patient Page: Behavioral Interventions for Weight Loss

To Learn More: The full report is available on the For The Media website.

(doi:10.1001/jama.2018.13022)

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.

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.

Listen to a Podcast: Aortic Vascular Inflammation and Coronary Artery Disease in Psoriasis

Posted September 10, 2018 by Jim Michalski

A podcast accompanies the JAMA Cardiology study, “Association Between Aortic Vascular Inflammation and Coronary Artery Plaque Characteristics in Psoriasis”, by Nehal N. Mehta, M.D., M.S.C.E., of the National Institutes of Health, Bethesda, Maryland, and coauthors, and the editorial, “Inflammation, Superadded Inflammation, and Out-of-Proportion Inflammation in Atherosclerosis,” by Jagat Narula, M.D., Ph.D., of the Icahn School of Medicine at Mount Sinai, New York, and coauthor, and is available for listening and download on this page.

Is Exposure to Lead, Cadmium Associated With Reduced Ability to See Contrast?

Posted September 11, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, SEPTEMBER 13, 2018

Media advisory: To contact corresponding author Adam J. Paulsen, M.S., email Emily Kumlien at EKumlien@uwhealth.org. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.3931

Bottom Line: Contrast sensitivity is a measure of how well someone sees an image against a background. Diminished contrast sensitivity can impact daily life because common low-contrast conditions include low light, fog or glare. Understanding what might contribute to a decrease in contrast sensitivity is important. An observational study of nearly 2,000 people taking part in an ongoing study of aging examined whether exposure to the heavy metals cadmium and lead was associated with increased risk of impaired contrast sensitivity. Results of the study suggest cadmium exposure, but not lead, was among the factors associated with increased risk. Cadmium exposure typically happens through inhaling cigarette smoke and eating green leafy vegetables, rice and shellfish. Limitations of the study include that no definitive conclusions can be drawn and that the association could be due to another element of cigarette smoking.

Authors: Adam J. Paulsen, M.S., University of Wisconsin-Madison, and coauthors

Related material: The commentary, “Examining the Association of Cadmium With Contrast Sensitivity,” by Xiang Li, Ph.D., Janssen Research & Development, LLC, Raritan, New Jersey, is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaophthalmol.2018.3931)

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.

Study Examines Law Enforcement-Inflicted Injuries Using California Hospital Data

Posted September 11, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, SEPTEMBER 14, 2018

Media advisory: To contact study author Renee Y. Hsia, M.D., M.Sc., email Elizabeth Fernandez at Elizabeth.Fernandez@UCSF.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.2150

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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 analysis of hospital visits in California shows trends in injuries inflicted by law enforcement officers in the line of duty and how those injuries were associated with the race and ethnicity of individuals they encountered.

Why The Research Is Interesting: Public concern about the use of police force has heightened but not much data are available about the resulting injuries.

What and When: 92,386 hospital visits in California from 2005 to 2015 were identified as resulting from “legal intervention injuries” (defined in injury codes as being inflicted by police or other law enforcement agents in the course of arresting, attempting to arrest, suppressing disturbances, maintaining order or other legal action)

What (Study Measures and Outcomes): All visits with injury codes classified as legal intervention injuries in men ages 14 to 64; the study analyzed trends in injury rates and disparities across racial and ethnic groups.

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Renee Y. Hsia, M.D., M.Sc., of the University of California, San Francisco, and coauthors

Results: Rates of injuries inflicted by law enforcement officers increased from 2005 to 2009 but declined through 2015, and black individuals were at greatest risk of these injuries per capita. The proportion of these injuries involving firearms, such as shootings by police, declined. In addition, an increasing proportion of emergency department visits associated with legal intervention injuries were associated with co-occuring behavioral health diagnoses.

Study Limitations: Results could have been affected by changes in hospital coding practices; there could be differences across race and ethnicity in reporting to clinicians that police inflicted the injury; and the study cannot determine in instances where force was used whether it was excessive.

Study Conclusions:

Related Material: The invited commentary, “Understanding Police Use of Force via Hospital Administrative Data: Prospects and Problems,” by Ojmarrh Mitchell, Ph.D., of the University of South Florida, Tampa, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.2150)

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 emailmediarelations@jamanetwork.org.

Did Tai Ji Quan Balance Training Program Reduce Fall Risk for Older Adults?

Posted September 6, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 10, 2018

Media advisory: To contact corresponding author Fuzhong Li, Ph.D., email fuzhongl@sus.edu.cn. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.3915

Bottom Line: A program of tai ji quan balance training classes, developed on the classic concept of tai chi, was more effective at reducing falls among older adults at high risk for them than stretching exercises or a training program that incorporated aerobic, strength, balance and flexibility exercises after six months. This randomized clinical trial included 670 adults (70 and older) in Oregon who had fallen in the previous year or who had impaired mobility. Limitations of the clinical trial include that it was conducted in a single state, had a small number of African American participants, and used self-reported fall data, although efforts were made to ensure its accuracy.

Authors: Fuzhong Li, Ph.D., of the Oregon Research Institute, Eugene, and Shanghai University of Sport, Shanghai, China, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.3915)

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 emailmediarelations@jamanetwork.org.

Video Abstract: Effect of Piperacillin-Tazobactam vs Meropenem in E coli or Klebsiella pneumoniae Infection

Posted September 6, 2018 by Jim Michalski

A video abstract is available for the JAMA study, “Effect of Piperacillin-Tazobactam vs Meropenem in E coli or Klebsiella pneumoniae Infection.” It is available for download or to embed on your website. Download the video as a high-quality MP4 file by clicking on this link and then right-clicking and selecting “save video as.” In addition, you may copy and paste the HTML code below to embed the video on your website.

Video embed code:

<div style="display: block; position: relative; max-width: 300px;"><div style="padding-top: 50%;"><iframe src="//players.brightcove.net/864352215001/default_default/index.html?videoId=5826583495001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

Association of Gestational Diabetes, Subsequent Glucose Metabolism Disorders in Mothers Under New Criteria

Posted September 6, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 11, 2018

Media advisory: To contact corresponding author Boyd E. Metzger, M.D., email Marla Paul at marla-paul@northwestern.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.11628

Bottom Line: Newer criteria mean more women are diagnosed with gestational diabetes than before. This observational study assessed whether untreated gestational diabetes defined after the fact based on newer criteria was associated with long-term risk of glucose metabolism disorders among 4,700 mothers and overweight or obesity in their children 10 to 14 years after pregnancy. Researchers report that untreated gestational diabetes was associated with development of glucose metabolism disorders (a composite of type 2 diabetes or prediabetes) in mothers but was not significantly associated with childhood overweight/obesity in combination. However, additional measures of fatness in children may be relevant in interpreting the study findings.

Authors: Boyd E. Metzger, M.D., Northwestern University Feinberg School of Medicine, Chicago, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.11628)

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.

Articles Focus on Medicaid Work Requirements

Posted September 6, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, SEPTEMBER 10, 2018

Media advisory: To contact corresponding author Anna L. Goldman, M.D., M.P.H., email David Cecere at dcecere@challiance.org and to contact corresponding author David M. Silvestri, M.D., M.B.A., email Anne Doerr at anne.doerr@yale.edu. The full articles are available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4194 (Goldman study) and http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4196 (Silvestri study)

Bottom Line: Two research letters and an invited commentary examine work requirements for Medicaid recipients, a move favored by some states that have federal waivers or have applied for them to impose work rules.

One research letter estimated the number of Medicaid recipients at risk of losing coverage if work requirements were applied nationally and in states with approved or pending waivers to impose those rules. The article also calculated Medicaid spending for those at risk of losing Medicaid coverage. Authors: Anna M. Goldman, M.D., M.P.H., of the Cambridge Health Alliance and the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and coauthors

A second research letter provides state-level population estimates of people who are subject to but not meeting proposed Medicaid work requirements. Authors: David M. Silvestri, M.D., M.B.A., of the Yale School of Medicine, New Haven, Connecticut, and coauthors

Related Material: The invited commentary, “Medicaid Work Requirements – English Poor Law Revisited,” by Dave A. Chokshi, M.D., M.Sc., and Mitchell H. Katz, M.D., of the NYC Health + Hospitals, also is available on the For The Media website. Dr. Katz is a JAMA Internal Medicine deputy editor.

To Learn More: The full articles are available on the For The Media website.

(doi:10.1001/jamainternmed.2018.4194 and doi:10.1001/jamainternmed.2018.4196)

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 emailmediarelations@jamanetwork.org.

Lethality of Active Shooter Incidents With vs. Without Semiautomatic Rifles

Posted September 6, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 11, 2018

Media advisory: To contact corresponding author Adil H. Haider, M.D., M.P.H., email Elaine St. Peter at estpeter@bwh.harvard.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.11009

Bottom Line: Semiautomatic rifles, which have been used in some of the largest shootings by individuals in U.S. history, were banned in 1994 under the federal assault weapons ban, but that expired in 2004. This study compared the number of people wounded and killed during active shooter incidents (defined by the FBI as an individual killing or attempting to kill people in a confined or populated area) with, and without, semiautomatic rifles from 2000 through 2017. Of 248 active shooter incidents, a semiautomatic rifle was used in about 25 percent of the shootings, while the rest involved handguns, shotguns and rifles that weren’t semiautomatic; 898 people were wounded and 718 were killed. Active shooter incidents with semiautomatic rifles were associated with a higher risk of people being wounded and killed. Limitations of the study include the lack of data on specific injuries, demographics and other details of the incidents.

Authors: Adil H. Haider. M.D., M.P.H., Brigham and Women’s Hospital, Boston, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.11009)

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.

Racial/Ethnic Disparities in Use of Low-Vision Devices among Medicare Recipients

Posted September 4, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, SEPTEMBER 6, 2018

Media advisory: To contact corresponding author Joshua R. Ehrlich, M.D., M.P.H., email Kara Gavin at kegavin@med.umich.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.3892

Bottom Line: Devices to assist individuals with low vision (uncorrectable vision impairment) are not covered by Medicare and many private insurers, although there is evidence that these devices, such as telescopic lenses, magnifiers, large print or talking materials, can improve functioning and quality of life. Little is known about whether sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries. This study included nationally representative survey data from about 3,000 Medicare beneficiaries 65 years and older with self-reported vision impairment. The authors found that compared with white individuals, adults from minority racial/ethnic groups were less likely to report using low-vision devices. However, they found no difference in the use of vision rehabilitation (evaluation of activities of daily living and implementation of a plan to improve functioning) – a service which is covered by Medicare – between racial/ethnic groups. A limitation of the study was the inability of the researchers to determine actual need for low-vision devices. If the findings are confirmed, it may suggest that policy makers could consider coverage of low-vision devices under Medicare to address disparities.

Authors: Joshua R. Ehrlich, M.D., M.P.H., University of Michigan Medical School, Ann Arbor, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaophthalmol.2018.3892)

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.

What is the Effect on Biomarkers of Smoke Exposure of Immediate Reduction of Nicotine Content in Cigarettes vs Gradual?

Posted August 30, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 4, 2018

Media advisory: To contact corresponding author Dorothy K. Hatsukami, Ph.D., email Krystle Barbour at kbarbour@umn.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.11473

Bottom Line: The optimal approach for reducing nicotine to minimally or nonaddictive levels in all cigarettes sold in the United States has not been determined. In this randomized clinical trial of 1,250 smokers, compared with gradual nicotine reduction, immediate reduction to 0.4 mg of nicotine per gram of tobacco cigarettes was associated with lower toxicant exposure across time, smoking fewer cigarettes per day, greater reduction in dependence and more cigarette-free days. However, the immediate reduction in nicotine caused greater withdrawal symptoms and higher study dropout rates. There was no significant difference between gradual reduction and the control group in decreases in biomarkers of smoke exposure across time. A limitation of the study was its duration of 20 weeks; the long-term effect of reduced nicotine content cigarettes is uncertain.

Authors: Dorothy K. Hatsukami, Ph.D., University of Minnesota, Minneapolis, and coauthors

Visual Abstract: This is the link to the abstract when the embargo lifts.

Related Material

— A video abstract that summarizes the results of this study is available for download or to embed on your website. Download the video as a high-quality MP4 file by clicking on this link and then right-clicking and selecting “save video as.” In addition, you may copy and paste the html code below to embed the video on your website.

— The JAMA article, “Drugs for Tobacco Dependence,” is available on the For The Media website.

Previously published related articles:

— From JAMA Psychiatry, Nondaily Smokers’ Changes in Cigarette Consumption With Very Low-Nicotine-Content Cigarettes

— From JAMA, Will the FDA’s New Tobacco Strategy Be a Game Changer?

— From JAMA Network Open, Association of Reduced Nicotine Content Cigarettes With Smoking Behaviors and Biomarkers of Exposure Among Slow and Fast Nicotine Metabolizers

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.11473)

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.

Video embed code:

<div style="display: block; position: relative; max-width: 300px;"><div style="padding-top: 50%;"><iframe src="//players.brightcove.net/864352215001/default_default/index.html?videoId=5826583486001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

USPSTF Recommendation Statement on Screening for Syphilis Infection in Pregnant Women

Posted August 30, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 4, 2018

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 is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time and all links to all USPSTF articles remain free indefinitely: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.11785

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) recommends early screening for syphilis infection in all pregnant women.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement is an update of its 2009 recommendation on screening for syphilis infection in pregnant women. Untreated syphilis infection in pregnant women can be transmitted to the fetus (congenital syphilis) at any time during pregnancy or at birth, and is associated with stillbirth, neonatal death, and significant illness in infants (such as bone deformities and neurologic impairment). After a steady decline from 2008 to 2012, cases of congenital syphilis markedly increased from 2012 to 2016.

The USPSTF Concludes:

Related Material

The following related elements from The JAMA Network are also available on the For The Media website:

— Screening for Syphilis Infection in Pregnant Women – US Preventive Services Task Force Reaffirmation Recommendation Statement

— Screening for Syphilis Infection in Pregnant Women – Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

— JAMA Dermatology editorial: Congenital Syphilis—Still a Shadow on the Land

— JAMA Patient Page: Screening for Syphilis in Pregnant Women

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.

Visual Abstract: Initial Laryngeal Tube Insertion vs Endotracheal Intubation Survival in Out-of-Hospital Cardiac Arrest

Posted August 23, 2018 by Jim Michalski

A Visual Abstract is available below for the JAMA study, “Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest,” by Henry E. Wang, M.D., M.S., the University of Texas Health Science Center at Houston, and coauthors.

This is the link to the abstract when the embargo lifts.

Higher Depression Risk in Young Adulthood Associated With Autism Spectrum Disorders

Posted August 28, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 31, 2018

Media advisory: To contact corresponding study author Dheeraj Rai, M.R.C.Psych., Ph.D., email dheeraj.rai@bristol.ac.uk. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1465

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Autism spectrum disorders (ASD), especially without an accompanying intellectual disability, were associated with greater risk for depression in young adulthood compared with the general population and siblings without ASD.

Why The Research Is Interesting: Mental health problems, including depression, are considered common in people with ASD. Understanding depression in people with ASD is important because it can further reduce social function. The identification and treatment of depression in people with ASD may help improve their quality of life.

Who and When: 223,842 individuals in Sweden followed up to age 27 by 2011, of whom 4,073 were diagnosed with ASD and 219,769 were not

What (Study Measures and Outcomes): Clinical diagnosis of depressive disorders identified in local and national patient registers

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Dheeraj Rai, M.R.C.Psych., Ph.D., of the University of Bristol, United Kingdom, and coauthors

Results:

Study Limitations: Study population may have included people with undiagnosed depression and others may have been misclassified as having depression.

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1465)

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 emailmediarelations@jamanetwork.org.

Use of Robotic Surgery Increasing

Posted August 23, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 28, 2018

Media advisory: To contact corresponding author Christopher P. Childers, M.D., email Enrique Rivero at ERivero@mednet.ucla.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.9219

Bottom Line: A new research letter suggests the use of robotic surgery continues to increase. Estimated annual procedures increased from 136,000 in 2008 to 877,000 in 2017, with 73 percent of them performed in the United States, according to an analysis of data from the primary supplier to hospitals of operating robotic systems.

Authors: Christopher P. Childers, M.D., and Melinda Maggard-Gibbons, M.D., M.S.H.S., of the David Geffen School of Medicine at University of California, Los Angeles

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.9219)

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.

Opioid Prescribing After Rhinoplasty

Posted September 4, 2018 by Deanna Bellandi

JAMA Facial Plastic Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, SEPTEMBER 6, 2018

Media Advisory: To contact corresponding author David A. Shaye, M.D., M.P.H., email Suzanne Day at Suzanne_Day@meei.harvard.edu. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Links will be live at the embargo time: http://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/10.1001/jamafacial.2018.0999

Bottom Line: A review of 173 patients who had rhinoplasty reports that nearly all were prescribed opioids (an average of 28 pills per patient) in addition to acetaminophen and refills were exceedingly rare, with some patients (11.3 percent) not even filling their initial narcotic prescription. Study results suggest patients experienced less pain than was expected, although the optimal number of tablets to manage postoperative pain from rhinoplasty is unclear.

Authors: David A. Shaye, M.D., M.P.H., of Harvard Medical School and Massachusetts Eye and Ear, Boston, Massachusetts, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamafacial.2018.0999)

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.

Trends Over 20 Years in ADHD Diagnoses Among U.S. Children, Adolescents

Posted August 28, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 31, 2018

Media advisory: To contact corresponding study author Wei Bao, M.D., Ph.D., email Tom Snee at tom-snee@uiowa.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1471

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Diagnosed attention-deficit/hyperactivity disorder (ADHD) in U.S. children and adolescents appears to have become more common over 20 years, with an increase in estimated prevalence from 6.1 percent to 10.2 percent between 1997 and 2016, although the cause of this apparent uptick still needs to be better understood.

Why The Research Is Interesting: Current estimates of the prevalence of ADHD and details on long-term trends are needed for research, clinical care and policymaking.

Who and When: 186,457 U.S. children and adolescents (ages 4 to 17) with data collected from 1997 to 2016 as part of the National Health Interview Survey

What (Study Measures and Outcomes): ADHD diagnosed by a physician or other health care professional

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Wei Bao, M.D., Ph.D., of the University of Iowa, Iowa City, and coauthors

Results:

Differences in how common diagnosed ADHD is in U.S. children and adolescents depend on age, sex, race/ethnicity, family income and geographic region, although all these subgroups showed an increase in prevalence from 1997 to 2016.

Reasons behind the increase in prevalence need to be better understood because other factors that could partly explain it include increased physician awareness about ADHD, changes in diagnostic criteria, and increased public awareness and better access to health care services that could lead to a higher likelihood of ADHD diagnosis.

Study Limitations: Parent-reported information about physicians’ diagnoses could result in misreporting; it wasn’t known whether children and adolescents with a diagnosis of ADHD still had ADHD at the time of the survey

Study Conclusions:

Related Material: The invited commentary, “Paying Attention to Attention-Deficit/Hyperactivity Disorder,” by Daniel P. Dickstein, M.D., of Brown University, East Providence, Rhode Island, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1471)

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 emailmediarelations@jamanetwork.org.

Study Estimates Firearm Deaths Globally in 2016

Posted August 24, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 28, 2018

Media advisory: To contact corresponding author Mohsen Naghavi, M.D., Ph.D., email Kelly Bienhoff at kbien@uw.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10060

Bottom Line: Around the world there were an estimated 195,000 to 276,000 firearm deaths in 2016, the majority of them homicides, compared with 1990 when there were an estimated 172,000 to 235,000 firearm deaths.

Why The Research Is Interesting: Understanding global firearm death rates and variation between countries can help to guide prevention policies and interventions.

What and When: Deaths due to firearms (homicides, suicides and unintentional deaths) in 195 countries and territories from 1990 to 2016

What (Study Measures and Outcomes): Firearm ownership and access (exposures); deaths by age, sex, location and year (outcomes).

How (Study Design): This was a data analysis.

Authors: Mohsen Naghavi, M.D., Ph.D., Institute for Health Metrics and Evaluation, University of Washington, Seattle, and coauthors

Results:

Study Limitations: A number of study imitations exist, including that the accuracy of estimates in the study depend on the availability of data and the quality and completeness of the data vary.

Related material available on the For The Media website:

— A Summary Video: This video reviews findings from a Global Burden of Disease study that estimates rates of firearm homicide and suicide and unintentional gun deaths in 195 countries and territories between 1990 and 2016, with editorial commentary by Daniel Webster, Sc.D., M.P.H., Director of the Johns Hopkins Center for Gun Policy and Research. Daniel Webster can be contacted at dwebster@jhu.edu.

The video is available for download or to embed on your website. Download the video as a high-quality MP4 file by clicking on this link and then right-clicking and selecting “save video as.” In addition, you may copy and paste the html code below to embed the video on your website.

— The JAMA editorial, “Firearm-Related Mortality – A Global Public Health Problem,” by Frederick P. Rivara, M.D., M.P.H., University of Washington, Seattle, and Editor in Chief, JAMA Network Open, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.10060)

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.

Video embed code:

<div style="display: block; position: relative; max-width: 300px;"><div style="padding-top: 50%;"><iframe src="//players.brightcove.net/864352215001/default_default/index.html?videoId=5816149748001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

CDC Guideline on Diagnosis, Management of Mild Traumatic Brain Injury in Children

Posted August 30, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, SEPTEMBER 4, 2018

Media advisory: To contact corresponding author Matthew J. Breiding, Ph.D., email Tiffany Mallory at wvn7@cdc.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.2853

Bottom Line: A Centers for Disease Control and Prevention evidence-based guideline on the diagnosis and management of mild traumatic brain injury (concussion) in children is detailed in a special communication article. The guideline includes 19 sets of recommendations on the diagnosis, prognosis, management and treatment of pediatric mild traumatic brain injury, including return to school and symptom management.

Authors: Matthew J. Breiding, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors

Related Material: The review article, “Diagnosis and Management of Mild Traumatic Brain Injury in Children: A Systematic Review,” by Matthew J. Breiding, Ph.D., of the Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors, and the editorial, “State of the Science on Pediatric Mild Traumatic Brain Injury: Progress Toward Clinical Translation,” by Michael McCrea, Ph.D., A.B.P.P., of the Medical College of Wisconsin, Milwaukee, and Geoff Manley, M.D., Ph.D., of the University of California, San Francisco, also are available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.2853)

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.

Disparities in Geographic Distribution of Dermatologists

Posted September 4, 2018 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, SEPTEMBER 5, 2018

Media Advisory: To contact corresponding author Jennifer A. Stein, M.D., Ph.D., email Jamie Liptack at Jamie.Liptack@nyulangone.org. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Link will be live at the embargo time http://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.3022

Bottom Line: Disparities exist in the geographic distribution of dermatologists across the United States in this study of county-level data from 1995 to 2013. Although the dermatologist workforce increased during that time and dermatologist density increased more in rural and nonmetropolitan counties than metropolitan areas, the gap in dermatologist density between metropolitan and other areas widened. Researchers stress that correcting the dermatologist workforce disparity is important for patient care.

Authors: Jennifer A. Stein, M.D., Ph.D., of the New York University School of Medicine, New York, and coauthors

To Learn More: The full study is available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamadermatol.2018.3022)

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.

U.S. Soldiers Who Attempt Suicide Often Have No Prior Mental Health Diagnosis

Posted August 27, 2018 by Deanna Bellandi

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 29, 2018

Media Advisory: To contact corresponding author Robert J. Ursano, M.D., email Sarah Marshall at sarah.marshall@usuhs.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2018.2069

Bottom Line: The latest study based on data from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) reports that among 9,650 enlisted soldiers with a documented suicide attempt, more than one-third had no prior mental health diagnosis. Risk factors for attempting suicide (sociodemographic, service-related, physical health care-related, injury, being subject to crime, perpetrating crime and family violence) were similar for soldiers with or without a prior mental health diagnosis, although the degree to which they were factors differed. Risk factors most strongly associated with suicide attempt by soldiers with no prior mental health diagnosis included being in their first year of service. Being female, having less than a high school education, delayed promotion and past-year demotion increased the odds of suicide attempt in both groups of soldiers with or without a prior mental health diagnosis but the effect was more so in soldiers without a prior mental health diagnosis. The study is limited by administrative data that reflect only events that came to the Army’s attention. Study results suggest administrative records from personnel, medical, legal and family service systems could help to identify soldiers at risk for suicide attempt.

Authors: Robert J. Ursano, M.D., of the Uniformed Services University of the Health Sciences, Bethesda, Maryland, and coauthors

Related Material: The editorial, “Suicide Prevention in the U.S. Army: A Mission for More Than Mental Health Clinicians,” by Mark A. Reger, Ph.D., of the Veterans Affairs Puget Sound Health Care System, Seattle, Washington, and coauthors also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/ jamapsychiatry.2018.2069)

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.

ACA Associated With Decrease in Cost-Related Medication Nonadherence Among Survivors of Stroke

Posted August 23, 2018 by Deanna Bellandi

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 27, 2018

Media Advisory: To contact corresponding author Deborah A. Levine, M.D., M.P.H., email Haley Otman at otmanh@med.umich.edu.The full study is available on the For The Media website.

To place an electronic embedded link in your story: Links will be live at the embargo time: http://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2018.2302

Bottom Line: Implementation of the Affordable Care Act (ACA) was associated with a decrease in cost-related nonadherence to medication by adult survivors of stroke (ages 45 to 64), as Medicaid coverage increased and uninsurance decreased in this group. This study analyzed survey data and included almost 14,000 survivors of stroke. Adults younger than 65 who survive stroke frequently contend with high out-of-pocket costs, especially for prescription drugs because they take an average of 11 medications. Study limitations include self-reported data and that researchers couldn’t account for medication-taking attitudes or behaviors.

Authors: Deborah A. Levine, M.D., M.P.H., of the University of Michigan, Ann Arbor, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaneurol.2018.2302)

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.

# # #

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

Providing Care for Transgender Patients

Posted August 20, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 27, 2018

Media advisory: To contact corresponding author Nicole Rosendale, M.D., email Suzanne Leigh at Suzanne.Leigh@ucsf.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4179

Bottom Line: A review article discusses some best practices to help clinicians learn how to better engage with and care for transgender patients, and the article suggests ways health care facilities can move toward more inclusive systems of care.

Authors: Nicole Rosendale, M.D., of the University of California, San Francisco, and coauthors

Featured Image: The image provides gender identity terminology and definitions.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.4179)

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 emailmediarelations@jamanetwork.org.

How Not Saying ‘Cancer’ for Low-Risk Thyroid Cancer May Affect Treatment Preferences, Patient Anxiety

Posted August 21, 2018 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 23, 2018

Media advisory: To contact corresponding author Kirsten McCaffery, Ph.D., email kirsten.mccaffery@sydney.edu.au. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2018.1272

Bottom Line: Could removing “cancer” from the terminology for low-risk small papillary thyroid cancers (PTCs) reduce patients’ anxiety so they consider less invasive treatment than surgery and avoid possible overtreatment for what can be indolent tumors? An online survey study of 550 Australian men and women without thyroid cancer suggests the answer is “maybe.” Total and partial surgical removal of the thyroid are the most common management approaches for patients with PTC, but those procedures come with surgical risk, lifetime medication management and anxiety. In the study, when hypothetical scenarios described PTC as a lesion or abnormal cells, survey respondents were more likely to pick nonsurgical options such as active surveillance and they reported lower levels of anxiety.

Authors: Kirsten McCaffery, Ph.D., the University of Sydney, New South Wales Australia, and coauthors

Related material available on the For The Media website:

— A podcast interview is available for listening and download on this page.

— The commentary, “The Evolving Nomenclature of Thyroid Cancer,” by Andrew G. Shuman, M.D., University of Michigan Medical School, Ann Arbor.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaoto.2018.1272)

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.

Study Explores Use of Eye Imaging for Identification of Preclinical Alzheimer Disease

Posted August 21, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 23, 2018

Media advisory: To contact corresponding authors Rajendra S. Apte, M.D., Ph.D., or Gregory P. Van Stavern, M.D., email Judy Martin at martinju@wustl.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.3556

Bottom Line: It is important to identify people with early-stage Alzheimer disease (AD) who could potentially benefit from treatment but current testing to do this is invasive and expensive. Optical coherence tomographic angiography (OCTA) is a noninvasive imaging technique of the eye that allows for analysis of certain changes of the retina that are altered in preclinical AD even prior to any symptoms. This study included 58 eyes from 30 cognitively normal adults (without any evidence of dementia) who underwent testing for biomarkers of preclinical AD and OCTA. Among the 30 people, 14 had biomarkers positive for AD and a diagnosis of preclinical AD; the other 16 people without biomarkers were used as a comparison group. While the study suggests certain changes in the retina were more likely among people with preclinical AD, larger studies are needed to determine the value of this finding in identifying early-stage AD.

Authors: Rajendra S. Apte, M.D., Ph.D., and Gregory P. Van Stavern, M.D., Washington University in St. Louis, and coauthors

Related material: The commentary, “Viewing Retinal Vasculature in Alzheimer Disease,” by Christine A. Curcio, Ph.D., University of Alabama at Birmingham, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaophthalmol.2018.3556)

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

Policy Intended to Curb Opioid Prescribing Associated With Increase in Filled Opioid Prescriptions after Surgery

Posted August 20, 2018 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 22, 2018

Media advisory: To contact corresponding author Jennifer Waljee, M.D., M.P.H., email Shantell Kirkendoll at smkirk@umich.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2018.2651

Bottom Line: The U.S. Drug Enforcement Administration in 2014 moved to limit prescribing of pain medications containing the opioid hydrocodone from schedule III (a class of controlled substances) to the more restrictive schedule II. As a result, commonly prescribed formulations of hydrocodone were limited to a 90-day supply and could no longer be prescribed by telephone or fax. This analysis examined opioid prescriptions filled by about 22,000 privately insured patients who had common elective surgical procedures from 2012 to 2015 in Michigan. Researchers found that changing hydrocodone to the more restrictive schedule II was associated with an increase in the amount of opioids filled in the initial prescription after surgery. Most of the increase was accounted for by hydrocodone, which was the most commonly prescribed opioid following surgery. Date were drawn from a single state so the study observations may not be generalizable to other regions. Future efforts aimed at curbing opioid prescribing should include prescriber education and follow-up to make sure corresponding reductions in opioid prescribing result.

Authors: Jennifer Waljee, M.D., M.P.H., University of Michigan, Ann Arbor, and coauthors

To Learn More: The full study is available on the For The Media website.

Related material: The JAMA Surgery study, “Association of the Use of a Mandatory Prescription Drug Monitoring Program With Prescribing Practices for Patients Undergoing Elective Surgery,” by Richard J. Barth Jr., M.D., Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, and coauthors is also available on the For The Media website.

(doi:10.1001/jamasurg.2018.2651)

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

Decline in Uninsured Hospitalizations for Cardiovascular Events After ACA Medicaid Expansion

Posted August 21, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 24, 2018

Media advisory: To contact corresponding study author Ehimare Akhabue, M.D., email Marla Paul at marla-paul@northwestern.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1296

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Medicaid expansion under the Affordable Care Act (ACA) was associated with a decline in the proportion of uninsured hospitalizations for major cardiovascular events such as heart attack, stroke and heart failure.

Why The Research Is Interesting: Cardiovascular disease is the leading primary hospital discharge diagnosis and the most common cause of death in the United States. This study examined how state decisions about whether to expand Medicaid under the ACA were associated with changes in uninsured hospitalizations for these major cardiovascular events.

What and When: More than 3 million non-Medicare hospitalizations between 2009 and 2014 from inpatient databases in 30 states (17 expanded Medicaid; 13 didn’t)

What (Study Measures and Outcomes): State Medicaid expansion as of January 2014 (exposure); comparison of the average payer mix proportions (uninsured, Medicaid, and privately insured) and in-hospital mortality between expansion and nonexpansion states before the ACA Medicaid expansion (2009-2013) and in the year (2014) after the expansion (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Ehimare Akhabue, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, Illinois, and co-authors

Results:

Study Limitations: Total number of hospitalizations for cardiovascular events could have been underestimated; data were only available for one year after ACA implementation; and only 30 states were included in the analysis

Study Conclusions:

Related Material: The invited commentary, “Medicaid Expansion and In-Hospital Cardiovascular Mortality: Failure or Unrealistic Expectations,” by Rishi K. Wadhera, M.D., M.Phil., of Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and Karen E. Joynt Maddox, M.D., M.P.H., of the Washington University School of Medicine in St. Louis, Missouri, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1296)

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.

# # #

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

Frequency of Prenatal Marijuana Use for Nausea, Vomiting in Pregnancy

Posted August 16, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 20, 2018

Media advisory: To contact corresponding author Kelly C. Young-Wolff, Ph.D., M.P.H., email Healther Platisha at Heather.Platisha@creation.io. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.3581

Bottom Line: Is prenatal marijuana use higher among women diagnosed with nausea and vomiting in pregnancy? A new research letter used data from Kaiser Permanente Northern California, which screens pregnant women for marijuana use through self-report and urine toxicology tests, to examine more than 220,000 pregnancies from 2009 through 2016. While the overall frequency of marijuana use in the first trimester was 5.3 percent, women with mild or severe nausea and vomiting in pregnancy had greater odds of marijuana use in the first trimester compared to women without nausea and vomiting in pregnancy. National guidelines suggest pregnant women discontinue the use of marijuana during pregnancy.

Authors: Kelly C. Young-Wolff, Ph.D., M.P.H., of Kaiser Permanente Northern California, Oakland, California, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.3581)

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.

# # #

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

Adolescents’ Concern Over Societal Discrimination Associated With Worse Behavioral Health

Posted August 16, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 20, 2018

Media advisory: To contact corresponding author Adam M. Leventhal, Ph.D., email Gary Polakovic at polakovi@usc.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.2022

Bottom Line: Many southern California high school students report being concerned that discrimination is increasing in society and that concern appears to be associated with behavioral health problems a year later, including more frequent substance use and higher odds of depression and attention-deficit/hyperactivity disorder symptoms. The authors of this survey study suggest public health attention and policy changes may be needed to address how public expressions of discrimination may affect adolescent health.

Authors: Adam M. Leventhal, Ph.D., of the Keck School of Medicine at the University of Southern California, Los Angeles, and coauthors

Related Material: The editorial, “Structuring Research to Address Discrimination as a Factor in Child and Adolescent Health,” by Nia Heard-Garris, M.D., M.Sc., of the Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.2022)

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.

# # #

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

Higher Cost to Medicare for Use of Brand-Name Combo Drugs Instead of Generic Components

Posted August 16, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 21, 2018

Media advisory: To contact corresponding author Chana A. Sacks, M.D., M.P.H., email Elaine St. Peter at estpeter@bwh.harvard.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.11439

Bottom Line: Brand-name combination drugs can be more expensive than the sum of their parts, especially when generic components are available. An analysis of Medicare Part D spending suggests $925 million is the difference between what Medicare reported spending in 2016 for 29 brand-name combination drugs and what the estimated spending would have been if generic components had been used for the same number of doses. Prescriber education and more rational substitution policies may help promote generic substitution and therapeutic interchange to save money in the Medicare drug benefit program.

Authors: Chana A. Sacks, M.D., M.P.H., Brigham and Women’s Hospital and Harvard Medical School, Boston, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.11439)

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.

USPSTF Recommendation Statement on Screening for Cervical Cancer

Posted August 16, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 21, 2018

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 is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time and all links to all USPSTF articles remain free indefinitely: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10897

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) has updated its recommendations regarding screening for cervical cancer, with the recommendations and type of screening method varying depending on the woman’s age and other factors.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement is an update of its 2012 recommendation on screening for cervical cancer. The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening. Most cases occur among women who have not been adequately screened.

The USPSTF Concludes:

Related material

The following related elements from The JAMA Network are also available on the For The Media website:

— A podcast interview with Carol M. Mangione, M.D., M.S.P.H., Task Force member and co-author of the recommendation statement, is available for listening and downloading on this page. The transcript of the podcast can be found here.

— Screening for Cervical Cancer – US Preventive Services Task Force Recommendation Statement

— Screening for Cervical Cancer With High-Risk Human Papillomavirus Testing – Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

— Screening for Cervical Cancer in Primary Care – A Decision Analysis for the US Preventive Services Task Force

— JAMA editorial: Screening for Cervical Cancer – New Tools and New Opportunities

— JAMA Internal Medicine editorial: Cervical Cancer Screening – Moving From the Value of Evidence to the Evidence of Value

— JAMA Patient Page: Screening for Cervical Cancer

To Learn More: The full report is available on the For The Media website.

(doi:10.1001/jama.2018.10897)

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.

Having Optimal Levels of Cardiovascular Health in Older Age Associated With Lower Dementia Risk

Posted August 16, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 21, 2018

Media advisory: To contact corresponding author Cecilia Samieri, Ph.D., email cecilia.samieri@u-bordeaux.fr. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.11499

Bottom Line: Having optimal levels in more measures of cardiovascular health (nonsmoking, weight, diet, physical activity, cholesterol, blood glucose and blood pressure) for older adults was associated with lower risk for dementia. This observational study included 6,626 adults in France 65 or older. A lower risk for dementia and lower rates of cognitive decline were associated with each additional metric at the recommended optimal level based on an American Heart Association seven-item checklist aimed at preventing cardiovascular disease. Limitations of the study include participants who were mostly urban and white so the results may not be generalizable to other groups and changes over time in cardiovascular health metrics were not accounted for because they were measured only at the start of the study.

Authors: Cecilia Samieri, Ph.D., Universite de Bordeaux, Bordeaux, France, and coauthors

Related material: The editorial, “Striving for Ideal Cardiovascular and Brain Health,” by Jeffrey L. Saver, M.D., University of California, Associate Editor, JAMA, and Mary Cushman, M.D., M.Sc., Larner College of Medicine at the University of Vermont, Burlington, and study, “Association of Cardiovascular Risk Factors With MRI Indices of Cerebrovascular Structure and Function and White Matter Hyperintensities in Young Adults,” by Paul Leeson, Ph.D., F.R.C.P., University of Oxford, United Kingdom, and coauthors are also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.11499)

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.

Listen to a Podcast: Association of Left Ventricular Global Longitudinal Strain With Asymptomatic Severe Aortic Stenosis

Posted August 13, 2018 by Jim Michalski

A podcast accompanies the JAMA Cardiology study, “Association of Left Ventricular Global Longitudinal Strain With Asymptomatic Severe Aortic Stenosis,” by Jeroen J. Bax, M.D., Ph.D., Leiden University Medical Center, Leiden, the Netherlands, and coauthors, and is available for listening and download on this page.

How Common Among U.S. Adults is the Perception of a Phantom Odor?

Posted August 14, 2018 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 16, 2018

Media advisory: To contact corresponding author Kathleen E. Bainbridge, Ph.D., M.P.H., email news@nidcd.nih.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2018.1446

Bottom Line: The perception of phantom odors is a condition in which individuals think they smell odors that don’t actually exist. Anecdotal reports suggest it can be a debilitating condition, with the odors often described as foul, rotten or chemical. A new observational study estimates 6.5 percent of U.S. adults 40 and older perceive phantom smells. The study included about 7,400 adults who participated in the National Health and Nutrition Examination Survey. Prevalence was greater among women than men and among younger age groups. Only 11 percent of those affected had discussed a smell or taste problem with a clinician, which suggests increased awareness of the condition may help people seeking help or treatment.

Authors: Kathleen E. Bainbridge, Ph.D., M.P.H., National Institutes of Health, Bethesda, Maryland, and coauthors.

Related material: The commentary, “Prevalence and Risk Factors for Olfactory Hallucinations The Phantom Menace,” by David W. Hsu, M.D., Jeffrey D. Suh, M.D., University of California, Los Angeles School of Medicine, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaoto.2018.1446)

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.

Visual Abstract and Summary Video: Effect of Cell-Free DNA Screening on Miscarriage in Women With Pregnancies at High Risk of Trisomy 21

Posted August 9, 2018 by Jim Michalski

A Visual Abstract and Summary Video are available for the August 14 JAMA study, “Effect of Cell-Free DNA Screening vs Direct Invasive Diagnosis on Miscarriage Rates in Women With Pregnancies at High Risk of Trisomy 21,” by Laurent J. Salomon, M.D., Ph.D., Paris Descartes University, Paris, France, and coauthors.

The summary video is available for download or to embed on your website. Download the video as a high-quality MP4 file by clicking on this link and then right-clicking and selecting “save video as.” In addition, you may copy and paste the html code below to embed the video on your website.

Visual Abstract: This is the link to the abstract when the embargo lifts.

Video embed code:

<div style="display: block; position: relative; max-width: 300px;"><div style="padding-top: 50%;"><iframe src="//players.brightcove.net/864352215001/default_default/index.html?videoId=5813824067001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

Quality of YouTube Videos for Facial Plastics Information

Posted August 14, 2018 by Deanna Bellandi

JAMA Facial Plastic Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 16, 2018

Media Advisory: To contact corresponding author Boris Paskhover, M.D., email Tiffany Cody at tcody@njms.rutgers.edu. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Links will be live at the embargo time: http://jamanetwork.com/journals/jamafacialplasticsurgery/fullarticle/10.1001/jamafacial.2018.0822

Bottom Line: YouTube videos are a popular resource for facial plastics information. However, a new research letter that evaluated the quality of some of those videos suggests they can present biased information, offer an unbalanced assessment of risks and benefits, and be unclear about the qualifications of the practitioners featured.

Authors: Boris Paskhover, M.D., Rutgers New Jersey Medical School, Newark, New Jersey, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamafacial.2018.0822)

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.

Patient Motivations Behind Cosmetic Procedures

Posted August 13, 2018 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 15, 2018

Media Advisory: To contact corresponding author Murad Alam, M.D., M.S.C.I., M.B.A., email Marla Paul at marla-paul@northwestern.edu. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Link will be live at the embargo time http://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.2357

Bottom Line: What motivates patients to seek minimally invasive cosmetic procedures? Most patients want the procedures to please themselves, not others, and, apart from aesthetic appearance to look younger and fresher, patient motivations ranged from physical health and psychological well-being to looking good at work and increasing self-confidence. Those were among the findings of a new observational study that included 511 patients who competed a survey.

Authors: Murad Alam, M.D., M.S.C.I., M.B.A., of the Feinberg School of Medicine at Northwestern University, Chicago, Illinois, and coauthors

To Learn More: The full study is available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamadermatol.2018.2357)

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.

# # #

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

Intervention for Young Transgender Women to Reduce Risk of HIV

Posted August 9, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 13, 2018

Media advisory: To contact corresponding author Robert Garofalo, M.D., M.P.H., email Julie Pesch at JPesch@luriechildrens.org. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.2334

Bottom Line: Young transgender women who took part in an intervention to reduce HIV transmission and acquisition had a greater reduction in condomless sex acts than young transgender women who received standard preventive care with testing for HIV/sexually transmitted infections and counseling in a randomized clinical trial.

Why The Research Is Interesting: HIV is high among transgender women in the United States, including among young transgender women between the ages of 16 and 29. Condomless sex acts are a risk for acquiring and transmitting HIV. This clinical trial evaluated the Project LifeSkills intervention for reducing condomless sex acts among young transgender women through sharing information about HIV, motivating people to protect themselves and promoting skills such as condom use and sexual partner communication and negotiation.

Who and When: 190 young transgender women in a clinical trial conducted between March 2012 and August 2016 in Boston and Chicago; participants were between the ages of 16 and 29 and were assigned male sex at birth but now self-identify as female, transgender women or on the transfeminine spectrum; 21 percent had HIV at the baseline assessment

What (Study Measures and Outcomes): Primary outcome was change in the number of self-reported condomless anal or vaginal sex acts in the four months before a baseline assessment and reported later at interval visits through 12 months

How (Study Design): This was a randomized clinical trial (RCT). RCTs allow the strongest inferences to be made about the true effect of an intervention. However, not all RCT results can be replicated in real-world settings because patient characteristics or other variables may differ from those studied in the RCT.

Authors: Robert Garofalo, M.D., M.P.H., of the Ann & Robert H. Lurie Children’s Hospital and Feinberg School of Medicine, Northwestern University, Chicago, Illinois, and coauthors

Results: A greater reduction in condomless sex acts among young transgender women in the intervention suggests the intervention is both feasible and effective.

Study Limitations: Conducted only in two cities; the intervention included content on the process of medical gender transition, which may not resonate with some women who have either completed the transition or who don’t plan to start it.

Study Conclusions:

Related Material: The editorial, “Challenges and Successes in Evaluating HIV Prevention
for Young Transgender Women—Building Skills, Maintaining Trust,” by Brittany J. Allen, M.D., of the University of Wisconsin School of Medicine and Public Health, Madison, also is available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamapediatrics.2018.2334)

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.

# # #

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

Prescriptions for Opioid Use Disorder Treatment, Opioid Pain Relievers After ACA Medicaid Expansion

Posted August 14, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 17, 2018

Media advisory: To contact corresponding study author Brendan Saloner, Ph.D., email Barbara Benham at bbenham1@jhu.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1588

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Medicaid expansion under the Affordable Care Act (ACA) was associated with an overall increase in people filling prescriptions for buprenorphine with naloxone, which is a treatment for opioid use disorder, as well as an increase in people filling prescriptions for opioid pain relievers (OPRs) paid for by Medicaid in a data analysis from five states.

Why The Research Is Interesting: Opponents of the ACA have suggested Medicaid expansion worsened the opioid crisis because insurance let people access cheap opioid pain relievers. However, the insurance expansion under the ACA also could help to lessen the opioid crisis by increasing access to medication to treat opioid use disorder. This study used pharmacy claims data for five states (three that expanded Medicaid and two that didn’t) to examine changes in prescriptions filled for buprenorphine with naloxone and for opioid pain relievers after the ACA’s Medicaid expansion.

Who and When: 11.9 million individuals who filled two or more prescriptions for opioids during at least one year between 2010 and 2015 from California, Maryland, and Washington (Medicaid expansion states) and Florida and Georgia (nonexpansion states)

What (Study Measures and Outcomes): Medicaid expansion (exposure); rates per 100,000 county residents were calculated for buprenorphine with naloxone and for opioid pain reliever prescriptions overall and by different payment sources (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Brendan Saloner, Ph.D., of the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, and co-authors

Results: In the five states where data were analyzed, Medicaid expansion was:

Study Limitations: Data included from only five states; unobserved differences between states may be associated with the outcomes; and alternative explanations independent of the ACA could be driving prescription rates

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1588)

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 emailmediarelations@jamanetwork.org.

Traumatic Brain Injury May Be Associated with Increased Risk of Suicide

Posted August 9, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 14, 2018

Media advisory: To contact corresponding author Trine Madsen, Ph.D., email trine.madsen@regionh.dk. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10211

Bottom Line: An increased risk of suicide was associated with those residents of Denmark who sought medical attention for traumatic brain injury (TBI) compared with the general population without TBI in a study that used data from Danish national registers. A history of TBI has been associated with higher rates of self-harm, suicide and death than the general population. This observational study included nearly 35,000 deaths by suicide over 35 years, of which 3,536 (10.2 percent) had medical contact for TBI recorded as mild TBI (concussion), skull fracture without documented TBI, and severe TBI (head injuries with evidence of structural brain injury). The risk for suicide was higher among people with severe TBI, numerous medical contacts for TBI and longer hospital stays, with these patients at highest risk for suicide in the the first six months after hospital discharge. The study has several limitations, including no information on treatment received by patients with TBI and some people may not have sought medical treatment for TBI.

Authors: Trine Madsen, Ph.D., Danish Research Institute of Suicide Prevention, Psychiatric Center Copenhagen, Copenhagen, Denmark and coauthors

Related material: The editorial, “Traumatic Brain Injury and Risk of Suicide,” by Lee Goldstein, M.D., Ph.D., Boston University School of Medicine, Boston, and Ramon Diaz-Arrastia, M.D., Ph.D., University of Pennsylvania Perelman School of Medicine, Philadelphia, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.10211)

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.

Can Combining Low Doses of 3 High Blood Pressure Medications into One Pill Improve Blood Pressure Control?

Posted August 9, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 14, 2018

Media advisory: To contact corresponding author Ruth Webster, Ph.D., email rwebster@georgeinstitute.org.au. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10359

Bottom Line: Poorly controlled high blood pressure is a leading global public health problem requiring new treatment strategies. In most instances, inadequate blood pressure treatment can be mainly attributed to use of one medication, which has modest effectiveness. In a randomized clinical trial that included 700 patients in Sri Lanka with mild to moderate high blood pressure who were not receiving treatment or who were taking one medication, the daily use of a pill that contained low doses of three antihypertensive drugs for six months resulted in a greater percentage of patients achieving their target blood pressure goal.

Authors: Ruth Webster, Ph.D., The George Institute for Global Health, University of New South Wales, Sydney, Australia, and coauthors

Visual Abstract: This is the link to the abstract when the embargo lifts.

Related material:

— The editorial, “Low-Dose Combination Blood Pressure Pharmacotherapy to Improve Treatment Effectiveness, Safety, and Efficiency” by Mark D. Huffman, M.D., M.P.H., Northwestern University Feinberg School of Medicine, Chicago, and coauthors is also available on the For The Media website.

— A summary video is available for download or to embed on your website. Download the video as a high-quality MP4 file by clicking on this link and then right-clicking and selecting “save video as.” In addition, you may copy and paste the html code below to embed the video on your website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.10359)

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.

Video embed code:

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Is Parental Belief in Importance of Religion Associated With Lower Risk of Suicidal Behavior in Kids?

Posted August 6, 2018 by Deanna Bellandi

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, August 8, 2018

Media Advisory: To contact corresponding author Priya J. Wickramaratne, Ph.D., email Gregory Flynn at Gregory.Flynn@nyspi.columbia.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2018.2060

Bottom Line: Parents’ belief in the importance of religion was associated with a lower risk for suicidal behavior by their children regardless of a child’s own belief about the importance of religion and other known risk factors such as parental depression, suicidal behavior and divorce.

Why The Research Is Interesting: About 12 percent of adolescents in the United States report having thoughts about attempting suicide, and suicide is a primary cause of death among females 15 to 19. Religious and spiritual beliefs have gotten less attention in previous research examining risk factors of child and adolescent suicide. This study used data from a three-generation family study for children and adolescents whose parents were at high or low risk for major depressive disorder because of their grandparents’ depression status.

Who and When: 214 children from 112 nuclear families using data from a 30-year sample; most belonged to a Christian religious denomination

What (Study Measures): Parent and child psychiatric diagnoses and suicidal behaviors; the two measures of religiosity (religious belief) used were importance and attendance

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Priya J. Wickramaratne, Ph.D., of Columbia University Medical Center and the New York State Psychiatric Institute, New York, New York, and coauthors

Results: Higher parental belief in the importance of religion was associated with lower risk of suicidal behavior in children.

Study Limitations: The sample of parents and children had regional limitations regarding religious denominations represented; participants were white.

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/ jamapsychiatry.2018.2060)

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.

Association of Radiation Therapy Plus Lumpectomy in Reduced Risk of Dying in Women With DCIS

Posted August 7, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 10, 2018

Media advisory: To contact corresponding study author Steven A. Narod, M.D., email Sarah Warr at Sarah.Warr@wchospital.ca. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1100

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Lumpectomy plus radiation was associated with a small clinical benefit in reduced risk of breast cancer death compared with lumpectomy or mastectomy alone in women with ductal carcinoma in situ (DCIS), a noninvasive early form of breast cancer.

Why The Research Is Interesting: Patients with DCIS are often treated with radiation after lumpectomy, although it has remained unclear whether this can reduce the risk of dying from breast cancer.

Who and When: More than 140,000 U.S. women who had DCIS between 1998 and 2014; this study compared lumpectomy plus radiation vs. lumpectomy alone, lumpectomy vs. mastectomy, and lumpectomy plus radiation vs. mastectomy

What (Study Measures and Outcomes): Use of radiation and/or extent of surgery (exposures); breast cancer mortality rates within 15 years (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Steven A. Narod, M.D., of Women’s College Research Institute, in Ontario, Canada, and co-authors

Results: A small improvement in breast cancer survival was associated with radiation plus lumpectomy for DCIS. The absolute risk reduction was 0.27 percent, making it necessary to treat 370 women to save one life. Patients who had lumpectomy plus radiation had more local recurrences than the mastectomy patients but had fewer deaths.

Study Limitations: Some data were missing; investigators didn’t have information on tamoxifen use; treatments in the study population weren’t randomly assigned; and the possibility remains that the decision to undergo radiotherapy was associated with other favorable prognostic factors.

Study Conclusions:

Related Material: The invited commentary, “Systemic Effects of Radiotherapy in Ductal Carcinoma In Situ,” by Mira Goldberg, M.D., and Timothy J. Whelan, B.M., B.Ch., of McMaster University, Ontario, Canada, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1100)

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.

# # #

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

Was Brief Dermatologist Intervention Associated With Patient Behavior, Satisfaction?

Posted August 6, 2018 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, AUGUST 8, 2018

Media Advisory: To contact corresponding author Kimberly A. Mallett, Ph.D.,email Erin Colbourn at ecolbourn@psu.edu. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Link will be live at the embargo time http://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.2331

Bottom Line: A short intervention by dermatologists to assess patients’ risk of sun exposure, discuss their motivations and barriers regarding sun protection, and offer advice on sun protection options was associated with better sun protection behavior reported by patients and more satisfaction communicating with their dermatologist. This small observational study compared 72 patients who received the Addressing Behavior Change (ABC) intervention with 81 patients in a comparison group over several months.

Authors: Kimberly A. Mallett, Ph.D., of Pennsylvania State University, University Park, and coauthors

To Learn More: The full study is available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamadermatol.2018.2331)

Editor’s Note: The study includes a funding/support disclosure. 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.

USPSTF Recommendation Statement on Screening for Atrial Fibrillation with Electrocardiography

Posted August 2, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 7, 2018

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 is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time and all links to all USPSTF articles remain free indefinitely: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10321

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) concludes that the current evidence is insufficient regarding screening for atrial fibrillation, the most common type of irregular heartbeat, with electrocardiography (ECG), a noninvasive test that records the electrical activity of the heart.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement is a new recommendation on screening for atrial fibrillation with ECG. The prevalence of atrial fibrillation increases with age and it is a major risk factor for ischemic stroke.

The USPSTF Concludes:

Related material

The following related elements from The JAMA Network are also available on the For The Media website:

A podcast regarding the recommendation statement is available for listening and download.

Screening for Atrial Fibrillation With Electrocardiography – US Preventive Services Task Force Recommendation Statement

Screening for Atrial Fibrillation With Electrocardiography – Evidence Report and Systematic Review for the US Preventive Services Task Force

JAMA editorial – Electrocardiographic Monitoring for Prevention of Atrial Fibrillation–Associated Cardioembolic Stroke

JAMA Cardiology editorial – Electrocardiography Screening for Atrial Fibrillation

JAMA Internal Medicine editorial – Screening for Atrial Fibrillation Comes With Many Snags

JAMA Patient Page – Screening for Atrial Fibrillation With Electrocardiography

To Learn More: The full report is available on the For The Media website.

(doi:10.1001/jama.2018.10321)

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.

Listen to a Podcast: Efficacy and Safety of Further Lowering of LDL Cholesterol in Patients Starting With Very Low Levels

Posted July 31, 2018 by Jim Michalski

A podcast accompanies the JAMA Cardiology study, “Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels,” by Marc S. Sabatine, M.D., M.P.H., Brigham and Women’s Hospital, Boston, and coauthors, and is available for listening and download on this page.

Effect on Weight Gain in Young Children in 2 Randomized Clinical Trials

Posted August 2, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, AUGUST 7, 2018

Media advisory: To contact corresponding author Shari L. Barkin, M.D., M.S.H.S., email Craig Boerner at craig.boerner@vumc.org. To contact corresponding Ian M. Paul, M.D., M.Sc., email Katie Bohn at kej5009@psu.edu. The full studies are available on the For The Media website.

Want to embed a link to theses studies in your story? Links will be live at the embargo time. Here’s the link to the Barkin et al study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.9128 Here’s the link to the Paul et al study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.9432

Bottom Line: Two randomized clinical trials on the prevention of obesity in young children had differing results; one trial didn’t change body mass index (BMI) growth trajectories over three years among low-income children at risk for obesity and another trial showed some modest results.

What: In the trial that didn’t change BMI trajectories, researchers compared the effects over three years of a family-based program to build skills and change behaviors to prevent obesity with a school-readiness program in underserved children between the ages of 3 and 5 at risk for obesity but not yet obese. The study included 610 parent-child pairs.

Authors: Shari L. Barkin, M.D., M.S.H.S., Vanderbilt University School of Medicine, Nashville, and coauthors

Visual Abstract: This is the link to the abstract when the embargo lifts.

What: In a randomized clinical trial that showed some modest positive results, researchers examined the effect on children’s weight after three years of an intervention that helped parents respond to their children’s needs, including feeding, when they were sleepy, fussy, drowsy or alert and compared it with a home safety intervention. The study included 279 mother-child pairs, who began the intervention shortly after birth and the children were followed until age 3 years. The mothers had only given birth to one child.

Authors: Ian M. Paul, M.D., M.Sc., Penn State College of Medicine, Hershey, Pennsylvania, and coauthors

Conclusion: The educational intervention on responsive parenting behaviors resulted in a modest reduction in BMI z scores (which account for child age and sex) for children at age 3 but no significant difference in BMI percentile.

Related material: The editorial, “Preventing Obesity in Children,” by Jody W. Zylke, M.D., Deputy Editor, JAMA, and Howard Bauchner, M.D., Editor in Chief, JAMA, is also available on the For The Media website.

To Learn More: The full studies are available on the For The Media website.

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.

New Analysis Estimates Much Higher Death Toll from Hurricane Maria in Puerto Rico

Posted August 1, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, AUGUST 2, 2018

Media advisory: To contact corresponding author Alexis R. Santos-Lozada, Ph.D., email Joslyn Neiderer at jms1140@psu.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.10929

Bottom Line: Due to differences in methods, there have been various estimates of the number of deaths in Puerto Rico from Hurricane Maria, which hit the island on September 20, 2017. The official death toll has remained at 64 since December 2017. The official government death toll includes some deaths in which documentation of “hurricane-related” as the cause of death appears on the individual’s death certificate and does not account for indirect deaths, including from infectious disease outbreaks or lack of services (such as electricity, water, and medical care). Using death counts from vital statistics records, researchers estimate the number of hurricane-related deaths in Puerto Rico through December 2017 was 1,139. The authors note the estimate is conservative.

Authors: Alexis R. Santos-Lozada, Ph.D., Pennsylvania State University, University Park, Jeffrey T. Howard, Ph.D., University of Texas at San Antonio

To Learn More: The full study is available on the For The Media website.

Related material: In this JAMA Medical News article and podcast, Dr. Myriam Allende-Vigo, an endocrinologist practicing in Puerto Rico, recounts her experiences treating patients during and after last year’s hurricane.

(doi:10.1001/jama.2018.10929)

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

# # #

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

How Common is Endometrial Cancer in Women with Postmenopausal Bleeding?

Posted August 2, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, AUGUST 6, 2018

Media advisory: To contact study author Megan A. Clarke, Ph.D., M.H.S., email NCI Press Officers at ncipressofficers@mail.nih.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.2820

Bottom Line: Postmenopausal bleeding is a common symptom among most women with endometrial cancer but most women with postmenopausal bleeding won’t be diagnosed with endometrial cancer, findings that raise questions about how to best manage postmenopausal bleeding for the early detection of endometrial cancer.

Why The Research Is Interesting: Endometrial cancer diagnosed early is often curable with surgery but five-year survival rates plummet for late-stage disease. Accurate estimates of the frequency of postmenopausal bleeding in endometrial cancers and the risk of endometrial cancer in women with postmenopausal bleeding are needed to evaluate whether targeting women with postmenopausal bleeding for early detection is a useful strategy.

Who and When: Nearly 41,000 from 129 studies (34,000 women with postmenopausal bleeding and more than 6,000 women with endometrial cancer)

What (Measures and Outcomes): Pooled frequency of postmenopausal bleeding in women with endometrial cancer and the risk of endometrial cancer in women with postmenopausal bleeding

How (Study Design): This was a systematic review and meta-analysis. A meta-analysis combines the results of multiple studies identified in a systematic review and quantitatively summarizes the overall association between the same exposure and outcomes measured across all studies.

Authors: Megan A. Clarke, Ph.D., M.H.S., of the National Cancer Institute, Rockville, Maryland, and coauthors

Results: The pooled frequency of postmenopausal bleeding among women with endometrial cancer was 91 percent, while the pooled risk of endometrial cancer among women with postmenopausal bleeding was 9 percent.

Study Limitations: Some data were inconsistently reported and other available data were insufficient.

Study Conclusions:

Related Material: The invited commentary, “Opportunities for Early Detection of Endometrial Cancer in Women with Postmenopausal Bleeding,” by Kristen A. Matteson, Women and Infants Hospital, Providence, Rhode Island, and coauthors is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.2820)

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.

# # #

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

What Factors Might Contribute to Inclusive Culture in Health Care Organizations?

Posted July 31, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, AUGUST 3, 2018

Media advisory: To contact corresponding study author Jaya Aysola, M.D., D.T.M.&H., M.P.H., email Greg Richter at gregory.richter@uphs.upenn.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.1003

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Researchers compiled six factors that health care workers believe can contribute to an inclusive culture within health care organizations and promote a diverse workforce.

Why The Research Is Interesting: Diversity in the health care workforce is important for health care organizations to try to reduce care disparities, improve the cultural competencies of health care professionals and retain employees. But how health care organizations can best create an inclusive culture isn’t always clear. This study is a qualitative narrative analysis that sought to understand from health care workers – from executives to staff to trainees and students – the factors perceived to be associated with inclusion in health care organizations.

What and When: 315 narratives submitted by health care workers in June 2016 in response to an email asking for stories that reflected on inclusion at their organizations, which included hospitals, health science schools and outpatient facilities within a university-based health care system in Pennsylvania

What (Study Measures and Outcomes): Workplace experiences with inclusion, implications of those experiences, and recommendations to improve inclusion

How (Study Design): This was a qualitative narrative analysis.

Authors: Jaya Aysola, M.D., D.T.M.&H., M.P.H., of the University of Pennsylvania, Philadelphia, and coauthors

Results: Six broad factors emerged as being associated with inclusion in health care organizations; underlying them was the need to belong and to feel recognized and valued.

The six factors were:

Presence of discrimination
Silent witness (when discriminatory or insensitive actions or statements are witnessed but nothing is said)
Interplay between hierarchy, recognition and civility (differences in treatment based on status within an organization)
Effectiveness of leadership and mentors
Support for work-life balance
Perceptions of exclusion for some because of inclusion efforts

Study Limitations: The regionally limited findings may not be nationally generalizable and some groups were underrepresented in the study sample.

Study Conclusions:

Related Material: The invited commentary, “Promoting Inclusion in Academic Medicine,” by Elena Fuentes-Afflick, M.D, M.P.H., of the University of California, San Francisco, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.1003)

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 emailmediarelations@jamanetwork.org.

What Were Consequences of 2013 Measles Outbreak in New York?

Posted July 26, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 30, 2018

Media advisory: To contact corresponding author Jennifer B. Rosen, M.D., email Danielle De Souza at ddesouza@health.nyc.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.1024

Bottom Line: A new report describes the public health impact of a 2013 measles outbreak in New York when an unvaccinated adolescent returned to the city infectious with measles after visiting London, United Kingdom. Between March and June 2013, 58 people in New York City were identified as having measles, most of whom were unvaccinated because of parental refusal or intentional delay, and more than 3,300 exposed contacts were identified. The New York City Department of Health and Mental Hygiene spent almost $395,000 and more than 10,000 personnel hours responding to and controlling the outbreak.

Authors: Jennifer B. Rosen, M.D., of the New York City Department of Health and Mental Hygiene, New York, and coauthors

Related Material: The editorial, “Costs, Consequences and Policy Responses of Vaccine-Preventable Disease Outbreaks,” by Jason L. Schwartz, Ph.D., of the Yale School of Public Health, New Haven, Connecticut, and the JAMA Pediatrics Patient Page, “Measles,” are available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.1024)

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.

# # #

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

How Do Young People Feel About Guns, Gun Regulation in U.S.?

Posted July 26, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 30, 2018

Media advisory: To contact corresponding author Kendrin R. Sonneville, Sc.D., R.D., email Andrea LaFerle at alaferle@umich.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.1746

Bottom Line: National polls track adult opinions about guns and gun regulation but how do young feel about that? A new research letter describes youth opinions on guns and gun regulation that were drawn from themes in text message survey responses. The majority of the 772 survey respondents were white females with an average age of 18. Most survey respondents reported the belief that gun control laws could help reduce mass shootings.

Authors: Kendrin R. Sonneville, Sc.D., R.D., of the University of Michigan School of Public Health, Ann Arbor, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.1746)

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.

Mortality Rates Among Homeless Adults in Boston Who Avoid Shelters, Known as ‘Rough Sleepers’

Posted July 26, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 30, 2018

Media advisory: To contact corresponding author Jill S. Roncarati, Sc.D., M.P.H., P.A.-C, email Chris Sweeney at csweeney@hsph.harvard.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.2924

Bottom Line: A group of unsheltered homeless adults in Boston known as “rough sleepers” because they avoid shelters and instead sleep on park benches, in alleyways, train stations and abandoned cars had much higher mortality rates than homeless adults who slept in emergency shelters and the Massachusetts adult population in general. This 10-year observational study of 445 unsheltered homeless adults (of whom 134 died during the study period) was an attempt to understand more about this unique subpopulation of homeless adults. Common causes of death were noncommunicable diseases, such as cancer and heart disease, as well as substance use and chronic liver disease.

Authors: Jill S. Roncarati, Sc.D., M.P.H., P.A.-C, of the Harvard T.H. Chan School of Public Health, Boston, Massachusetts, and coauthors

Related Material: The invited commentary, “Death Among the Unsheltered Homeless: Hidden in Plain Sight,” by Michael Incze, M.D., M.S.Ed., of the University of California, San Francisco, and Mitchell H. Katz, M.D., of New York City Health and Hospitals and deputy editor of JAMA Internal Medicine, is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.2924)

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.

# # #

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

Risk of Later Death After Donor Blood, Marrow Transplant in Childhood

Posted July 24, 2018 by Deanna Bellandi

JAMA Oncology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 26, 2018

Media advisory: To contact corresponding author Smita Bhatia, M.D., M.P.H., email Beena Thannickal at beenat@uab.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2018.2453

Bottom Line: Patients who had donor blood or marrow transplants during childhood continue to be at increased risk of premature death even years after the procedure compared with the general population, although the rate of later death among these transplant patients has decreased over the last three decades. This observational study used data on cause of death for almost 1,400 individuals who lived two years or more after undergoing a donor transplant in childhood between 1974 and 2010. Leading causes of death were infection and chronic graft-vs-host disease, patients’ primary disease and subsequent cancers.

Authors: Smita Bhatia, M.D., M.P.H., of the University of Alabama at Birmingham, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaoncol.2018.2453)

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.

# # #

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

How Was Mediterranean Diet Associated with Severity of Psoriasis?

Posted July 23, 2018 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, JULY 25, 2018

Media Advisory: To contact corresponding author Céline Phan, M.D., email cel.phan@gmail.com. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Link will be live at the embargo time http://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.2127

Bottom Line: Adherence to a Mediterranean diet, an eating plan filled with fruits and vegetables, legumes, cereals, bread, fish, fruit, nuts and extra-virgin olive oil, may be associated with the severity of the skin condition psoriasis.

Why The Research Is Interesting: Psoriasis is a common chronic inflammatory skin condition. Studies have suggested adherence to a healthy diet, such as the Mediterranean diet, may reduce the risk of long-term systemic inflammation. This study assessed the association between a score that reflected adherence to the Mediterranean diet and the onset or severity of psoriasis.

Who and When: 35,735 respondents who are part of an ongoing, observational web-based questionnaire study launched in 2009, of whom 3,557 reported they had psoriasis; the condition was severe in 878 cases and 299 news cases were recorded as those arising more than two years after inclusion in the study group

What (Study Measures): Patients with psoriasis were identified via online self-completed questionnaire and categorized by disease severity; data on dietary intake were gathered during the first two years of participation in the study group to calculate a score reflecting adherence to a Mediterranean diet from 0 for no adherence to 18 for maximum adherence.

How (Study Design): This was an observational study. Because researchers were not intervening for purposes of the study they cannot control natural differences that could explain the study findings.

Authors: Céline Phan, M.D., of Hôpital Mondor, Créteil, France, and coauthors

Results: There was an “inverse” association between adherence to a Mediterranean diet and the severity of psoriasis, which suggests patients with severe psoriasis adhered less strongly to the Mediterranean diet, even after accounting for other potential mitigating factors.

Study Limitations: Study participants were all volunteers and they may be more concerned about their health than the general population, data were self-reported and some data were missing.

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

For more details and to read the full study, please visit the For The Media website.

(doi:10.1001/jamadermatol.2018.2127)

Editor’s Note: The study includes a funding/support disclosure. 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.

What Midlife Risk Factors Are Associated with Late Onset of Epilepsy?

Posted July 19, 2018 by Deanna Bellandi

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 23, 2018

Media Advisory: To contact corresponding author Emily L. Johnson, M.D., email Audrey M. Huang at audrey@jhmi.edu. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Links will be live at the embargo time:http://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2018.1935

Bottom Line: Potentially changeable lifestyle and vascular risk factors in midlife were associated with onset later in life of epilepsy, a neurological disorder with higher risk in older age. This observational study used data from a large, biracial group of people followed for more than 25 years. Hypertension, diabetes, smoking, apolipoprotein E ɛ4 allele status (variant of a gene associated with increased risk of developing Alzheimer disease), stroke and dementia were associated with increased risk of epilepsy. More physical activity and moderate alcohol intake were associated with lower risk.

Authors: Emily L. Johnson, M.D., of Johns Hopkins University School of Medicine, Baltimore, Maryland, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaneurol.2018.1935)

Editor’s Note: The article includes a conflict of interest disclosure. 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.

Can Treatment for Depression after a Heart Attack Reduce the Long-Term Risk of Another Cardiac Event?

Posted July 19, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 24, 2018

Media advisory: To contact corresponding author Jae-Min Kim, M.D., Ph.D., email jmkim@chonnam.ac.kr. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.9422

Bottom Line: Depression has been associated with poorer medical outcomes for patients with acute coronary syndrome (ACS), including heart attack and unstable angina. This randomized clinical trial of 300 patients in South Korea examined whether antidepressant treatment after ACS improved long-term cardiac outcomes. Patients received either the antidepressant escitalopram or placebo for 24 weeks. After about eight years of follow-up, the antidepressant escitalopram resulted in a lower occurrence of major adverse cardiac events than placebo (40.9 percent vs. 53.6 percent).

Authors: Jae-Min Kim, M.D., Ph.D., Chonnam National University Medical School, Gwangju, Republic of Korea, and co-authors

Visual Abstract: This is the link to the abstract when the embargo lifts.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.9422)

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.

Updated Recommendations for Treating, Preventing HIV Infection

Posted July 19, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 24, 2018

Media advisory: To contact corresponding author Michael S. Saag, M.D., email Savannah Koplon at skoplon@uab.edu. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8431

Bottom Line: A volunteer panel of experts in HIV research and patient care evaluated new data and treatments to update recommendations from the International Antiviral Society–USA for the use of antiretroviral drugs in this special communication article. The updated recommendations encompass initiating therapy, monitoring individuals starting therapy, changing regimens and preventing HIV infection for individuals at risk. Advances in the prevention and treatment of HIV continue to improve clinical management and outcomes for patients with HIV and those at risk. A two-part podcast on the history of AIDS accompanies this article, as well as other related articles listed below.

Authors: Michael S. Saag, M.D., University of Alabama at Birmingham, and coauthors

Related material:

– The first episode of a two-part podcast on the history of AIDS, “Working on the Precipice: On the Frontlines of the AIDS Epidemic at the CDC, Part I,” is available to preview on the For The Media website. The second episode will be live at 11 a.m. ET on August 1.

– A promo of the podcast is available for immediate use. Coming next week (July 24) to the JAMA Clinical Reviews #podcast: JAMA Deputy Editor Ed Livingston embarks on a two-part look at the #CDC clinicians on the frontlines of the emerging #AIDS crisis in the 80s.

– The editorial, “2018 IAS-USA Recommendations for the Use of Antiretroviral Therapy for HIV,” by James Riddell IV, M.D., University of Michigan Medical Center, Ann Arbor, is available on the For The Media website.

– A JAMA article and accompanying podcast, “Anthony Fauci, M.D.: Working to End HIV/AIDS,” are available here and here. A Viewpoint article by Dr. Fauci, “An HIV Vaccine Is Essential for Ending the HIV/AIDS Pandemic,” is available here.

To Learn More: The full report is available on the For The Media website.

(doi:10.1001/jama.2018.8431)

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.

Screening for Paternal Depression in Primary Care Clinics

Posted July 19, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 23, 2018

Media advisory: To contact corresponding author Erika R. Cheng, Ph.D., M.P.A., email Andrea Zeek at anzeek@iu.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.1505

Bottom Line: Fathers screened positive for depression almost as often as mothers during well-child care visits with their young children in a small study at community health care centers in Indianapolis, Indiana. Researchers estimated the frequency of paternal depression using the Child Health Improvement Through Computer Automation (CHICA) system, which administers a tablet-based prescreening form to English- and Spanish-speaking parents in waiting rooms. The study analyzed parent responses from more than 9,500 clinic visits and 4.4 percent of fathers (36) screened positive for depression, which is comparable to the overall proportion of mothers who screened positive (273 or 5.0 percent). The results suggest pediatric clinics are promising places to address depression in a family.

Authors: Erika R. Cheng, Ph.D., M.P.A., of the Indiana University School of Medicine, Indianapolis, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.1505)

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.

# # #

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

Association Between Firearm Caliber and Likelihood of Death From Gunshot

Posted July 24, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 27, 2018

Media advisory: To contact corresponding study author Anthony A. Braga, Ph.D., email Shannon Nargi at s.nargi@northeastern.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.0833

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: The caliber of a firearm was associated with the likelihood of death from a gunshot, with shootings by large-caliber handguns likely to be more deadly than small-caliber guns.

Why The Research Is Interesting: Whether the caliber of a weapon affects the outcome of a shooting is a controversial issue in the debate over gun regulation. Some contend it is the intent of the shooter, not the type of weapon, that determines whether someone who is shot will live or die. That belief is enshrined in the slogan: “guns don’t kill people; people kill people.” Others, including medical and public health professionals, widely believe that the likelihood of death increases with the power of the weapon.

What and When: Data on shooting cases from Boston Police Department investigation files for assaults that took place from 2010 to 2014; police determined firearm caliber in 183 fatal cases and 184 nonfatal cases; those 367 cases were divided into three groups by caliber: small (.22, .25 and .32), medium (.38, .380 and 9 mm) or large (.357 magnum, .40, .44 magnum, .45, 10 mm and 7.62 x 39 mm)

What (Study Measures and Outcomes): Caliber of the firearm used to shoot the victim (exposure); whether the victim died from the gunshot wound (outcome)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Anthony A. Braga, Ph.D., of Northeastern University, Boston, Massachusetts, and Philip J. Cook, Ph.D., of Duke University, Durham, North Carolina

Results: Compared to shootings with small-caliber guns, the odds the victim will die are higher when medium- and large-caliber guns are used.

Study Limitations: It is possible shooters who used large-caliber guns were somehow more determined to kill or more skillful at it; caliber wasn’t available for all shootings; and the study was limited to criminal shootings known to the police

Study Conclusions:

Related Material: The invited commentary, “Fighting Unarmed Against Firearms,” by Angela Sauaia, M.D, Ph.D., and Ernest E. Moore, M.D., of the University of Colorado, Denver, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.0833)

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 emailmediarelations@jamanetwork.org.

Effect of Twice-Weekly Calorie Restriction Diet for Glycemic Control in Patients With Type 2 Diabetes

Posted July 17, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 20, 2018

Media advisory: To contact corresponding study author Peter M. Clifton, M.D., Ph.D., email peter.clifton@unisa.edu.au. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.0756

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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 diet with calorie restriction two days per week was comparable to a diet with daily calorie restriction for glycemic control in patients with type 2 diabetes.

Why The Research Is Interesting: Conventional weight-loss diets with daily calorie restriction are hard to stick with over time. Intermittent calorie restriction diets can be effective for weight loss. This study examined the long-term effects of a two-day intermittent calorie restriction diet with a diet of continuous calorie restriction over 12 months for patients with type 2 diabetes.

What and When: 137 patients with type 2 diabetes were assigned to 1 of 2 diets between April 2015 and September 2017

What (Study Interventions and Outcomes): 70 patients assigned to an intermittent calorie restriction diet (500-600 calories/day) on two nonconsecutive days with their regular diet the other five days per week and 67 patients assigned to a daily calorie restriction diet (1,200-1,500 calories/day) for 12 months (interventions); change in hemoglobin A_1c(primary outcome)

How (Study Design): This was a randomized noninferiority trial. This type of randomized clinical trial is designed to assess whether an intervention is “no worse” than the comparison intervention.

Authors: Peter M. Clifton, M.D., Ph.D., of the University of South Australia, Adelaide, and coauthors

Results: The average change in hemoglobin A_1c after a year was comparable between the two diets.

Study Limitations: The study population had well-controlled type 2 diabetes; medication adjustments can complicate interpreting changes in hemoglobin A_1c levels; and study participants had more contact with a dietitian than is usual in a clinical setting

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.0756)

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.

# # #

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

Are Vision Impairments More Frequent Among Children with Developmental Dyslexia?

Posted July 17, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 19, 2018

Media advisory: To contact corresponding author Aparna Raghuram, O.D., Ph.D., email Bethany Tripp at Bethany.Tripp@childrens.harvard.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.2797

Bottom Line: Developmental dyslexia emerges in childhood and is a reading disorder believed to involve language processing deficits. Reading is also a visual task but the potential role of visual processing in developmental dyslexia has been controversial. This study was a small observational study to assess the frequency of visual deficits in 29 children with developmental dyslexia compared with 33 typically developing reading children. Deficiencies in some measures of visual function were more common among children with developmental dyslexia than children who were typically developing. The cause and clinical relevance of the study findings are uncertain and more studies are needed to see if treating visual function deficiencies improves reading in children with developmental dyslexia.

Authors: Aparna Raghuram, O.D., Ph.D., Boston Children’s Hospital, Boston, and coauthors

Related material: The commentary, “Is Oculomotor Testing Important in Developmental Dyslexia?” by Scott A. Larson, M.D., University of Iowa, Iowa City, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaophthalmol.2018.2797)

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.

Association of Monthly High-Dose Vitamin D Supplementation and Cancer Risk

Posted July 17, 2018 by Deanna Bellandi

JAMA Oncology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 19, 2018

Media advisory: To contact corresponding author Robert Scragg, M.B.B.S., Ph.D., email r.scragg@auckland.ac.nz. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2018.2178

Bottom Line: Monthly high-dose vitamin D supplementation without calcium for up to four years wasn’t associated with reduced cancer risk among adults in New Zealand. This study analyzed data from a randomized clinical trial that included a placebo group. There were 328 total cases of cancer, with 165 among 2,558 participants (6.5 percent) who received monthly high-dose vitamin D supplementation and 163 among 2,550 participants (6.4 percent) in the placebo group. This study suggests monthly high-dose vitamin D supplementation should not be used for cancer prevention.

Authors: Robert Scragg, M.B.B.S., Ph.D., of the University of Auckland, New Zealand, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaoncol.2018.2178)

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.

# # #

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

Association of Complementary Medicine, Cancer Treatment, Survival

Posted July 17, 2018 by Deanna Bellandi

JAMA Oncology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 19, 2018

Media advisory: To contact corresponding author James B. Yu, M.D., M.H.S., email Anne Doerr at anne.doerr@yale.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2018.2487

Bottom Line: The use of complementary medicine by patients with four common cancers (breast, prostate, lung or colorectal) was associated with refusal of conventional cancer treatment and with a greater risk of death, although the difference in survival may be alleviated by adherence to all recommended conventional cancer therapies.

Why The Research Is Interesting: Complementary medicine is intended to be used in addition to conventional cancer therapy. Patients use a wide variety of complementary medicine, which can include herbs and botanicals, vitamins and minerals, traditional Chinese medicine, specialized diets, homeopathy and naturopathy, to improve their quality of life and with the hope of prolonging it. This study used a large national database to examine the use of complementary medicine by patients and delays in, or refusal of, conventional cancer therapies

Who and When: From among 1.9 million patients in the National Cancer Database, 258 patients who used complementary medicine were compared with 1,032 who didn’t; patients were diagnosed with nonmetastatic breast, prostate, lung or colorectal cancer between 2004 and 2013

What (Study Measures and Outcomes): Use of complementary medicine (defined as “other-unproven: cancer treatments administered by nonmedical personnel”) in addition to at least one conventional cancer therapy, which was defined as surgery, radiotherapy, chemotherapy or hormone therapy (exposures); overall survival, adherence to treatment and patient characteristics (outcomes)

Study Design: This was an observational study. Researchers were not intervening for purposes of the study and cannot totally control for all the natural differences that could explain the study results.

Authors: Skyler B. Johnson M.D., and James B. Yu, M.D., M.H.S., and coauthors at the Yale School of Medicine, New Haven, Connecticut

Results:

Limitations: The use of complementary medicine by patients was likely understated because patients are often hesitant to report its use to their clinicians; other factors unaccounted for could have influenced survival; and there are inherent limitations in the study’s design

Study Conclusions:

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaoncol.2018.2487)

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.

# # #

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

Lower Default Amount of Opioid Pills in Electronic Medical Record May Reduce Opioid Prescribing

Posted July 16, 2018 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, JULY 18, 2018

Media advisory: To contact corresponding author Alexander S. Chiu, M.D., email Ziba Kashef at ziba.kashef@yale.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2018.2083

Bottom Line: Lowering the default amount of opioid pills prescribed to patients in a health care system’s electronic medical record was associated with a deccrease in the amount of opioids prescribed systemwide.

Why The Research Is Interesting: Numerous attempts have been made to change the culture of opioid prescribing. One potential approach is changing the computerized clinician order entry systems in electronic medical record (EMR) systems. In these systems, prescriptions for opioids can autopopulate with a default number of pills prescribed.

What (Study Intervention and Outcomes) and When: Default number of opioid pills lowered in a health care system’s EMR from 30 to 12 in 2017 (intervention); change in median number of opioid pills and total dose prescribed postoperatively before and after the default number of opioid pills was changed.

How (Study Design): This before-and-after study compared postoperative prescribing patterns for 1,447 surgical procedures during three months before the default number of opioid pills was lowered with 1,463 procedures during three months after the change

Authors: Alexander S. Chiu, M.D., Yale School of Medicine, New Haven, Connecticut, and coauthors

Results:

Study Limitations: Study reflects the experience of a single health system; unclear if the results can be reproduced at other institutions; long-term follow-up is needed; and unaccounted factors could have influenced the change in prescribing patterns.

Study Conclusions:

Related material: The commentary, “How to Combat the Opioid Epidemic, 1 Nudge at a Time,” by Nancy N. Baxter, M.D., Ph.D., University of Toronto, and coauthors is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamasurg.2018.2083)

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.

Do Stress Balls or Hand Holding Reduce Anxiety During Skin Cancer Surgery?

Posted July 16, 2018 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, JULY 18, 2018

Media Advisory: To contact corresponding author Murad Alam, M.D., M.S.C.I., M.B.A., email Marla Paul at marla-paul@northwestern.edu. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Link will be live at the embargo time http://jamanetwork.com/journals/jamadermatology/fullarticle/10.1001/jamadermatol.2018.1783

Bottom Line: Exploring whether hand-holding or squeezing a stress ball would reduce patient anxiety during skin cancer surgery under local anesthesia was the main focus of this randomized clinical trial. The study of 135 patients at an urban academic medical center reports that patients who used stress balls or whose hands were held weren’t less anxious, didn’t experience less pain and were no more satisfied with the procedure than other patients.

Authors: Murad Alam, M.D., M.S.C.I., M.B.A., of the Feinberg School of Medicine at Northwestern University, Chicago, Illinois, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamadermatol.2018.1783)

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.

Pattern of Association Between Toddler Self-Regulation, Kindergarten Obesity Risk

Posted July 12, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 16, 2018

Media advisory: To contact corresponding author Sarah E. Anderson, Ph.D., email Misti Crane at crane.11@osu.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.0413

Bottom Line: Obesity is among the long-term adult health consequences associated with poor self-regulation during childhood. This study of a nationally representative group of U.S. children suggests the pattern of an association between levels of toddler self-regulation and risk for obesity at kindergarten age differs between boys and girls. This observational study suggests the frequency of obesity was lower among boys with the most self-regulation but, among girls, obesity was highest among those with the most and the least self-regulation. More research is needed to replicate these findings but they may be a clue about different results for boys and girl in efforts to prevent obesity by improving childhood self-regulation.

Authors: Sarah E. Anderson, Ph.D., of Ohio State University, Columbus, and Robert C. Whitaker, M.D., M.P.H., of Temple University, Philadelphia, Pennsylvania

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.0413)

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.

# # #

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

Study Examines Strength of Evidence of Drugs Granted ‘Breakthrough’ Approval

Posted July 12, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 17, 2018

Media advisory: To contact corresponding author Joseph S. Ross, M.D., M.H.S., email Ziba Kashef at ziba.kashef@yale.edu. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7619

Bottom Line: The U.S. Food and Drug Administration (FDA) created the Breakthrough Therapy designation in 2012 to expedite the development and review of drugs and biologics intended to treat serious or life-threatening conditions when preliminary clinical evidence suggested better improvement over existing therapies. This study reviewed the 46 therapeutics with Breakthrough Therapy designation approved by the FDA from 2012 through 2017. Results suggest trials supporting those drugs granted that designation commonly enrolled small numbers of patients and lacked randomization and control groups.

Authors: Joseph S. Ross, M.D., M.H.S., Yale University School of Medicine, New Haven, Connecticut, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.7619)

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.

Is There an Association Between More Frequent Use of Digital Media by Teens and Symptoms of ADHD?

Posted July 12, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 17, 2018

Media advisory: To contact corresponding author Adam M. Leventhal, Ph.D., email Gary Polakovic at polakovi@usc.edu or call 213-740-9226. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8931

Translation available: A translation in simplified Chinese is available below.

本篇新闻发布稿件备有翻译版本：以下内容为中文简体翻译版本

Bottom Line: Frequent use of digital media may be associated with the development of attention-deficit/hyperactivity disorder (ADHD) symptoms in adolescence but more research is needed to know if the association is causal.

Why The Research Is Interesting: Digital media, including texting, video chatting and social media sites, are accessible, constantly available on mobile devices and intensely stimulating. But whether frequent use of this modern digital media is associated with the occurrence of ADHD symptoms in adolescence is unknown.

Who and When: 2,587 Los Angeles County high school students without symptoms of ADHD at study entry who were surveyed five times from September 2014 to December 2016.

What (Study Measures and Outcomes): Self-reported use of 14 different digital media activities, such as checking social media sites and texting (exposures); self-rated frequency of 18 ADHD symptoms in the six months preceding the survey (outcomes).

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Adam M. Leventhal, Ph.D., University of Southern California Keck School of Medicine, Los Angeles, and coauthors

Results: Frequently using multiple forms of digital media was associated with a higher likelihood of ADHD symptoms occurring over a 24-month period during adolescence.

Study Limitations: A self-rating survey for ADHD symptoms is insufficient to determine an ADHD diagnosis; there also is the possibility of reverse causation (ADHD is associated with sensation seeking which could prompt digital media use to satisfy a need for stimulation); and undetected baseline ADHD symptoms cannot be ruled out.

Study Conclusions:

Related material: The editorial, “Digital Media and Symptoms of Attention-Deficit/Hyperactivity Disorder in Adolescents,” by Jenny Radesky, M.D., University of Michigan School of Medicine, Ann Arbor, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.8931)

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.

Translation in Simplified Chinese

中文简体翻译版本

禁止提前报道指令解除时间：2018年7月17日，星期二，美国东部时间上午11点

媒体咨询：联系通讯作者Adam M. Leventhal, Ph.D.，请发电子邮件到Gary Polakovic polakovi@usc.edu。

青少年频繁使用数字媒体与注意力缺陷/多动症(ADHD)的症状有关联吗？

概要: 根据《美国医学会杂志》(JAMA)发表的一项研究，频繁使用数字媒体可能与青春期注意力缺陷/多动症（ADHD）症状的发展有关，但需要更多的研究来了解这种关联是否是因果关系。

为何对该问题感兴趣：数字媒体，包括短信，视频聊天和社交媒体网站等，都可以通过移动设备随时访问，并且非常刺激。但是目前还不知道经常使用这些现代数字媒体与青春期ADHD症状的发生是否有关。

研究参与者及时间： 2587名在研究开始时没有ADHD症状的洛杉矶县高中生, 其在2014年9月至2016年12月期间接受了五次研究调查。

研究内容（研究手段及结果）：自我报告的14种不同数字媒体活动的使用情况，例如查看社交媒体网站和发短信等（暴露）; 自我评定的调查前六个月内18种ADHD症状频率（结果）。

如何研究(研究设计)：这是一项观察性研究。研究人员不会为研究目而进行干预，也无法控制可以解释研究结果的所有自然差异。

作者：Adam M. Leventhal, Ph.D., 南加州大学凯克医学院，洛杉矶, 以及共同作者

研究结果：频繁使用多种形式的数字媒体与在青春期时期的24个月内出现ADHD症状的可能性升高有关联。

研究局限：针对ADHD症状的自我评估不足以确定ADHD诊断; 还存在反向因果关系的可能性（ADHD与寻求感觉刺激有关，而这可能促使更多的使用数字媒体来满足刺激需求）; 并且不能排除未检测到的基线ADHD症状。

研究结论：

结论及意义 在接受2年随访的青春期青少年中, 频繁使用数字媒体与其后的ADHD症状表现出有统计意义的中等关联度。但还需要进一步的研究以确定该关联是否是因果关系。

欲了解更多信息：在下面网站可以获得该研究的全文，For The Media：https://media.jamanetwork.com/。

Public Attention on Cognitive Evaluation Test Used on President Trump

Posted July 12, 2018 by Deanna Bellandi

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 16, 2018

Media Advisory: To contact corresponding author Hourmazd Haghbayan, M.D., email hourmazd.haghbayan@mail.utoronto.ca. The full study is available on the For The Media website.

To place an electronic embedded link in your story: Links will be live at the embargo time: http://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2018.1777

Bottom Line: A screening test used in a cognitive evaluation of President Donald Trump received considerable public attention after it was announced earlier this year. A new study identified online news articles discussing the Montreal Cognitive Assessment (the “MoCA”) in association with President Trump and internet search trends during the days immediately following his medical assessment. Approximately half of all news articles embedded or hyperlinked to all or parts of the questionnaire, while 1 in 6 articles directly invited readers to take the test. What, if anything, will result from public sharing of a version of the test isn’t clear, however, researchers caution clinicians to be aware of patients’ potential prior exposure to the test and temporarily consider the use of alternate versions of the MoCA questionnaire until further study is completed on the impact of this diffusion to the public.

Authors: Hourmazd Haghbayan, M.D., of the University of Toronto, Canada, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaneurol.2018.1777)

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.

Comparison of Outpatient Antibiotic Prescribing in Traditional Medical, Retail Clinic Settings

Posted July 12, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 16, 2018

Media advisory: To contact study author Katherine E. Fleming-Dutra, M.D., email Martha Sharan at msharan@cdc.gov. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.1632

Translation available: A translation in simplified Chinese is available below.

本篇新闻发布稿件备有翻译版本：以下内容为中文简体翻译版本

Bottom Line: Outpatient antibiotic prescribing varied among traditional medical and retail clinic settings and during visits with respiratory diagnoses where antibiotics were inappropriate, patterns that suggest differences in patient mix and antibiotic overuse.

Why The Research Is Interesting: Antibiotic use contributes to antibiotic resistance, and antibiotic overuse is common, especially for viral respiratory infections. This study compared antibiotic prescribing patterns among urgent care centers, retail clinics, emergency departments and medical offices.

Who and When: Outpatient claims data from a 2014 database that captures claims data on people younger than 65 with employer-sponsored insurance

What (Measures and Outcomes): Outpatient claims at urgent care centers, retail clinics, hospital based-emergency departments or medical offices were each assigned a diagnosis (exposure); percentage of visits linked to prescription of antibiotics with a focus on respiratory diagnoses where antibiotics were unnecessary (outcomes)

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control all the natural differences that could explain the study findings.

Authors: Katherine E. Fleming-Dutra, M.D., of the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, and coauthors

Results:

Study Limitations: Researchers could not clinically validate diagnoses in claims data so misclassification was possible, data also are not generalizable to populations not captured in this claims database, and facility codes could not be validated.

Study Conclusions: Antibiotic stewardship, the effort to optimize antibiotic use, across the spectrum of outpatient settings could help to improve antibiotic prescribing and patient care.

Related Material: The patient page, “I Have a Cold – What Do I Need to Know,” and the invited commentary, “Overprescription in Urgent Care Clinics – the Fast and the Spurious,” by JAMA Internal Medicine Editor Rita F. Redberg, M.D., M.Sc., of the University of California, San Francisco, and coauthors also are available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamainternmed.2018.1632)

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.

# # #

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

Translation in Simplified Chinese

中文简体翻译版本

禁止提前报道指令解除时间：2018年7月16日，星期一，美国东部时间上午11点

媒体咨询：联系研究作者Katherine E. Fleming-Dutra, M.D.，请发电子邮件到Martha Sharan msharan@cdc.gov。

传统与零售诊所在门诊抗生素处方上的比较

概要: 根据《美国医学会杂志-内科学》(JAMA Internal Medicine)发表的一项研究，传统和零售诊所在门诊抗生素处方上有所不同,而当有不适合使用抗生素的呼吸诊断的病人就诊时，不同类型的门诊在患者组成及抗生素过度使用等方面都有区别。

为何对该问题感兴趣：抗生素的使用可能会导致抗生素耐药性，而抗生素过度使用是很常见的，特别是对于病毒性呼吸道感染。本研究比较了紧急护理中心，零售诊所，急诊室和医院门诊的抗生素处方模式。

研究参与者及时间：2014年数据库中的门诊索赔数据，该数据库记录了使用通过工作获得保险的65岁以下人群的索赔数据

研究内容（研究手段及结果）：紧急护理中心，零售诊所，医院急诊室以及医院门诊的索赔均被分配一种诊断（暴露）; 与抗生素处方相关的就诊百分比，并重点关注不需要抗生素的呼吸道诊断（结果）

如何研究(研究设计)：这是一项观察性研究。研究人员不会为研究目而进行干预，也无法控制可以解释研究结果的所有自然差异。

作者：Katherine E. Fleming-Dutra, M.D., 疾病预防与控制中心，佐治亚州亚特兰大, 以及共同作者

研究结果： 270万紧急护理中心就诊中的39.0％，58,206零售诊所就诊中的36.4％，480万急诊室就诊中的13.8％以及1亿485万医院门诊就诊中的7.1％与抗生素处方相关。

研究局限：研究人员无法临床验证索赔数据中的诊断，因此可能出现错误分类，数据也不能推广到未记录在此索赔数据库中的人群，并且无法验证各医疗设施代码。

研究结论：

在各个不同门诊类型中，抗生素管理，优化抗生素使用的努力可以帮助改善抗生素处方和患者护理。

欲了解更多信息：在下面网站可以获得该研究的全文，For The Media：https://media.jamanetwork.com/。

Study Estimates Eyeglass Use by Medicare Patients

Posted July 10, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 12, 2018

Media advisory: To contact corresponding author Brian C. Stagg, M.D., email Shantell Kirkendoll at smkirk@umich.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.2524

Bottom Line: Traditional Medicare doesn’t cover eyeglasses except after cataract surgery and changing the policy has been discussed. Recent estimates of eyeglass use by Medicare beneficiaries could shed light on the implications of any policy change. A new study estimates 92 percent of Medicare beneficiaries 65 or older (an estimated 40.5 million people) reported using eyeglasses for distance or near vision correction in 2015, a frequency of eyeglass use that has remained stable. Researchers noted sociodemographic differences between those who did or didn’t report using eyeglasses.

Authors: Brian C. Stagg, M.D., University of Michigan Medical School, Ann Arbor, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaophthalmol.2018.2524)

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.

Is Risk for Inner Ear Disorders Higher in People with History of Migraines?

Posted July 10, 2018 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 12, 2018

Media advisory: To contact corresponding author Yi-Chun Chen, M.D., email alineycc@gmail.com; to contact corresponding author Jen-Tsung Lai, M.D., email earlar0401@gmail.com. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2018.0939

Bottom Line: A study of health insurance claims data from Taiwan suggests there may be increased risk of inner ear disorders, especially ringing in the ears, among patients with a history of migraines than those without.

Authors: Juen-Haur Hwang, M.D., Ph.D., Yi-Chun Chen, M.D., Tzu Chi University, Hualien, Taiwan, and Jen-Tsung Lai, M.D., Kuang-Tien General Hospital, Shalu, Taichung, Taiwan, and coauthors

To Learn More: The full study is available on the For The Media website.

Related material: The commentary, “The Role of Migraine in Hearing and Balance Symptoms,” by Harrison W. Lin, M.D. and Hamid R. Djalilian, M.D., of the University of California, Irvine, is also available on the For The Media website.

(doi:10.1001/jamaoto.2018.0939)

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 Prenatal Depression in 2 Generations of Pregnant Mothers

Posted July 10, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 13, 2018

Media advisory: To contact corresponding study author Rebecca M. Pearson, Ph.D., email rebecca.pearson@bristol.ac.uk. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.0725

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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 two generations of women in England examined how common depression during pregnancy (prenatal depression) is in young mothers now compared with their mothers’ generation. Depressed mood was measured using self-reported surveys in both generations and analysis of the data suggests depression in young pregnant women may be higher now than among their mothers’ generation in the 1990s. Researchers acknowledge a number of plausible explanations for their findings requiring further study.

Authors: Rebecca M. Pearson, Ph.D., of the University of Bristol, United Kingdom, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.0725)

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 emailmediarelations@jamanetwork.org.

Study Examines Emergency Department Suicide Prevention Intervention

Posted July 9, 2018 by Deanna Bellandi

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, JULY 11, 2018

Media Advisory: To contact corresponding author Barbara Stanley, Ph.D., email Gregory Flynn at Gregory.Flynn@nyspi.columbia.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2018.1776

Bottom Line: Patients who are suicidal often seek care at a hospital emergency department (ED). This comparison study of about 1,600 patients at nine Veterans Health Administration hospital EDs (five delivered the intervention and four delivered usual care for comparison) examined suicidal behavior and behavioral health outpatient services from medical records in the six months after ED discharge. Researchers report the intervention (safety planning which included personalized identification of warning signs, coping skills and social supports in combination with telephone follow-up care) was associated with reduced suicidal behavior and increased likelihood of attending mental health treatment.

Authors: Barbara Stanley, Ph.D., of Columbia University, New York State Psychiatric Institute, New York, New York, and coauthors

Related Material: An author podcast is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/ jamapsychiatry.2018.1776)

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.

# # #

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

What is the Association Between Asthma and Atrial Fibrillation Risk?

Posted July 9, 2018 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, JULY 11, 2018

Media advisory: To contact corresponding author Aivaras Cepelis, M.Sci., email aivaras.cepelis@ntnu.no. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2018.1901

Bottom Line: Researchers report moderately increased risks for atrial fibrillation (AF), an irregular and often rapid heart rate, in adults with asthma and a lack of asthma control in a study that included about 54,000 individuals in Norway, although underlying causes for the association still need to be understood.

Authors: Aivaras Cepelis, M.Sci., Norwegian University of Science and Technology, Trondheim, Norway, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamacardio.2018.1901)

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.

Preoperative Opioid Use by Patients Having Surgery

Posted July 9, 2018 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, JULY 11, 2018

Media advisory: To contact corresponding author Paul E. Hilliard, M.D., email Kara Gavin at kegavin@med.umich.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/jamasurg.2018.2102

Bottom Line: Nearly 1 in 4 patients undergoing surgery at an academic medical center reported preoperative opioid use in a study of about 34,000 patients who underwent surgery from 2010-2016. Age, tobacco use, illicit drug use, higher pain severity, depression, lower life satisfaction and more coexisting medical conditions were associated with preoperative opioid use by patients before surgery. Identifying patients undergoing surgery who use opioids could help establish safe and effective pain management plans for this complicated patient population.

Authors: Paul E. Hilliard, M.D., University of Michigan Health System, Ann Arbor, and coauthors

Related material: The commentary, “Perioperative Opioid Management – An Opportunity to Put the Genie Back Into the Bottle,” by Michael A. Ashburn, M.D., M.B.A., M.P.H., and Lee A. Fleisher, M.D., of the University of Pennsylvania, Philadelphia, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamasurg.2018.2102)

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.

Can a Home-Based, Self-Applied ECG Patch Improve the Diagnosis of Atrial Fibrillation?

Posted July 5, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 10, 2018

Media advisory: To contact corresponding author Steven R. Steinhubl, M.D., email press@scripps.edu. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8102

Bottom Line: For approximately 20 percent of individuals who experience a stroke due to atrial fibrillation (AF; an irregular and often rapid heart rate), the occurrence of AF was not diagnosed until the time of their stroke or shortly afterward. Improved AF diagnosis and treatment could reduce the risk of stroke. In a randomized trial that included about 2,600 participants at increased risk of AF, immediate monitoring with a home-based, self-applied wearable ECG sensor patch resulted in a higher rate of AF diagnosis after four months compared with delayed monitoring (3.9 percent vs 0.9 percent). In an observational study, monitored individuals had higher rates of AF diagnosis, greater initiation of blood thinners, but also increased health care resource use at one year compared with non-monitored controls. Further research is needed regarding the clinical implications of these findings.

Authors: Steven R. Steinhubl, M.D., Scripps Translational Science Institute, La Jolla, California, and coauthors

To Learn More: The full study is available on the For The Media website.

Related material available on the For The Media website:

A summary video is available for download or to embed on your website. Download the video as a high-quality MP4 file by clicking on this link and then right-clicking and selecting “save video as.” In addition, you may copy and paste the html code below to embed the video on your website.

The editorials: “Evaluating Health Technology Through Pragmatic Trials,” by Eric D. Peterson, M.D., M.P.H., of Duke University Medical Center, Durham, North Carolina, and Robert A. Harrington, M.D., Stanford University, Stanford, California; and “Screening for Atrial Fibrillation With a Wearable Device,” by Benjamin A. Steinberg, M.D., M.H.S., University of Utah Health Sciences Center, Salt Lake City, and Jonathan P. Piccini, M.D., M.H.S., Duke University Medical Center, Durham, North Carolina.

(doi:10.1001/jama.2018.8102)

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.

Video embed code:

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Use of Prescribed Testosterone Therapy in U.S. Decreases in Recent Years

Posted July 5, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 10, 2018

Media advisory: To contact corresponding author Jacques Baillargeon, Ph.D., email Donna Ramirez at donna.ramirez@utmb.edu. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7999

Bottom Line: Testosterone use in the United States tripled from 2001 through 2011, mostly in men without a clear indication. In late 2013 and early 2014, two studies reported increased heart attack and stroke associated with testosterone use, and the U.S. Food and Drug Administration (FDA) issued a safety bulletin in early 2014. An examination of testosterone prescribing in the U.S. from 2002- 2016 found that the percentage of men receiving testosterone prescriptions decreased from 2013 through 2016, with the steepest decrease coinciding with the published reports of testosterone-associated adverse cardiovascular events and the FDA safety bulletin.

Authors: Jacques Baillargeon, Ph.D., University of Texas Medical Branch, Galveston, Texas, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.7999)

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.

Listen to a Podcast: Association of Inadequately Controlled Disease and Disease Severity With Patient-Reported Disease Burden in Adults With Atopic Dermatitis

Posted July 2, 2018 by Jim Michalski

An author podcast accompanies the JAMA Dermatology study, “Association of Inadequately Controlled Disease and Disease Severity With Patient-Reported Disease Burden in Adults With Atopic Dermatitis,” by Eric L. Simpson, M.D., Oregon Health & Science University, Portland, Oregon, and coauthors, and is available for listening and download on this page.

Can Acupuncture Reduce Treatment-Related Pain for Women with Early-Stage Breast Cancer?

Posted July 5, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 10, 2018

Media advisory: To contact corresponding author Dawn L. Hershman, M.D., M.S., email Alexandra Simpson at ajs9044@nyp.org. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8907

Bottom Line: Treatment for breast cancer with aromatase inhibitors often results in joint pain, which can contribute to treatment nonadherence. Several small studies have suggested that acupuncture may decrease aromatase inhibitor-related joint pain. In a randomized trial that included 226 postmenopausal women with early-stage breast cancer who were taking an aromatase inhibitor and experiencing joint pain, women who received acupuncture twice a week for six weeks had a greater reduction in pain compared with sham acupuncture (received acupuncture at non-acupuncture points) or those who did not receive any acupuncture. The observed improvement was of uncertain clinical importance.

Authors: Dawn L. Hershman, M.D., M.S., of NewYork-Presbyterian and Columbia University Irving Medical Center, New York, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.8907)

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.

What is Association of Infant Sleep, Early Introduction of Solid Foods?

Posted July 5, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, JULY 9, 2018

Media advisory: To contact corresponding author Gideon Lack, M.B., B.Ch., email gideon.lack@kcl.ac.uk. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.0739

Bottom Line: Infants waking during the night is a reason some British mothers introduce solid foods earlier than recommended by the British government, which advises exclusive breastfeeding for about six months. A secondary analysis of a randomized clinical trial that included infants from England and Wales looked at whether the early introduction of solid foods was associated with influences on infant sleep. Study results suggest small but significant improvements in infant sleep were associated with the group of infants whose mothers were encouraged to continue breastfeeding during the early introduction of some solid foods.

Authors: Gideon Lack, M.B., B.Ch., of King’s College London, England, and coauthors

Related Material: An author podcast also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamapediatrics.2018.0739)

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.

# # #

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

Two New USPSTF Recommendation Statements

Posted July 5, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 10, 2018

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 is available on the For The Media website.

Want to embed a link to these reports in your story? Links will be live at the embargo time and all links to all USPSTF articles remain free indefinitely. Here’s the link to the recommendation statement on screening for PAD and CVD risk assessment with the ABI: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8357 Here’s the link to the recommendation statement on risk assessment for CVD with nontraditional risk factors: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8359

Bottom Line: In two new statements, the U.S. Preventive Services Task Force (USPSTF) concludes current evidence is insufficient to make recommendations assessing cardiovascular disease (CVD) risk with certain nontraditional risk factors and screening for peripheral artery disease (PAD) and CVD risk with the ankle-brachial index (ABI).

What: In the first statement, evidence is insufficient to make a recommendation regarding screening for PAD and CVD risk with the ABI in asymptomatic adults.

What: In the second statement, evidence is insufficient to make a recommendation regarding adding the nontraditional risk factors of the ABI, high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score to traditional risk assessments for CVD in asymptomatic adults to prevent CVD events.

Related material

The following related elements from The JAMA Network are also available on the For The Media website:

— A podcast interview with Michael J. Barry, M.D., a member of the USPSTF and co-author of the recommendation statements.

— Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index – US Preventive Services Task Force Recommendation Statement

— Screening for Peripheral Artery Disease Using the Ankle-Brachial Index – Evidence Report and Systematic Review for the US Preventive Services Task Force

— Ankle-Brachial Index Screening and Improving Peripheral Artery Disease Detection and Outcomes – JAMA editorial

— Screening for Peripheral Artery Disease With Ankle-Brachial Index – JAMA Patient Page

— Risk Assessment for Cardiovascular Disease With Nontraditional Risk Factors – US Preventive Services Task Force Recommendation Statement

— Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment – Evidence Report and Systematic Review for the US Preventive Services Task Force

— USPSTF Recommendations for Assessment of Cardiovascular Risk With Nontraditional Risk Factors – JAMA editorial

— Viewing the Value of Coronary Artery Calcium Testing From Different Perspectives – JAMA Cardiology editorial

Editor’s Note: Please see the articles 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.

Can Greening Vacant Urban Land Improve Mental Health?

Posted July 17, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 20, 2018

Media advisory: To contact corresponding study author Eugenia C. South, M.D., M.S., email Katie Delach at Katharine.Delach@uphs.upenn.edu. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.0298

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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: Physical conditions in a neighborhood matter. Trash, a lack of sidewalks and parks, and vacant or dilapidated spaces have been associated with depression, while living near green spaces has been associated with less depression, anxiety and stress. In Philadelphia, a citywide cluster randomized trial looked at whether greening vacant urban land by getting rid of trash, grading the land, planting new grass and some trees, and installing low wooden fencing could improve self-reported mental health.

Authors: Eugenia C. South, M.D., M.S., of the University of Pennsylvania, Philadelphia, and coauthors

Featured Image: The image includes a correction to identify both series of photos as the greening intervention.

Related Material: The invited commentary, “Nature Exposure Gets a Boost From a Cluster Randomized Trial on the Mental Health Benefits of Greening Vacant Lots,” by Michael Jerret, Ph.D., of the University of California, Los Angeles, and Matilda van den Bosch, M.D., Ph.D., of the University of British Columbia, Vancouver, Canada, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.0298)

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 emailmediarelations@jamanetwork.org.

High Rate of Nearsightedness among Children in China

Posted July 2, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 5, 2018

Media advisory: To contact corresponding author Mingguang He, M.D., Ph.D., email mingguang_he@yahoo.com. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time http://jamanetwork.com/journals/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.2658

Translation available: A translation in simplified Chinese is available below.

本篇新闻发布稿件备有翻译版本：以下内容为中文简体翻译版本

Bottom Line: Nearsightedness (myopia) is a leading cause of visual impairment worldwide. A new study of about 4,700 Chinese schoolchildren suggests the rate of nearsightedness may be 20 percent to 30 percent each year from first grade onward. If such a frequency is confirmed with further testing, researchers suggest interventions to reduce the onset of nearsightedness, such as increasing the time spent outdoors, should be initiated in primary schools.

Authors: Mingguang He, M.D., Ph.D., Sun Yat-sen University, Guangzhou, China, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaophthalmol.2018.2658)

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.

Translation in Simplified Chinese

中文简体翻译版本

禁止提前报道指令解除时间：2018年7月5日，星期四，美国东部时间上午11点

媒体咨询：联系通讯作者Mingguang He, M.D., Ph.D.，请发电子邮件到mingguang_he@yahoo.com。

中国儿童近视率高

概要: 近视是全球视力损害的一个主要原因。一项针对约4700名中国学龄儿童的新研究表明，从一年级开始，每年的近视率可能达到20％至30％。根据《美国医学会杂志眼科学》(JAMA Ophthalmology) 上发表的一项研究，如果上述发生频率能被进一步的测试证实, 研究人员建议从小学开始采取干预措施来减少近视的发生，例如增加户外活动时间。

作者：: Mingguang He, M.D., Ph.D., 中山大学，中国广州，以及合作者

欲了解更多信息：在下面网站可以获得该研究的全文，For The Media：https://media.jamanetwork.com/。

How is Opioid Use Associated With Health, Other Substance Use, Involvement in Criminal Justice System?

Posted July 3, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JULY 6, 2018

Media advisory: To contact corresponding study author Tyler N.A. Winkelman, M.D., M.Sc., email Susan O’Reilly at soreilly@mmrf.org. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.0558

About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every 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 public health approach to address the opioid epidemic in the United States needs to understand the populations of people affected, including their health, other substance use and any involvement they may have with the criminal justice system. This study examined that using data from the 2015-2016 National Survey on Drug Use and Health. Researchers found people who reported any level of opioid use were more likely than those who reported no opioid use to have physical and mental health conditions, other substance use, and involvement in the criminal justice system that increased with the intensity of opioid use.

Authors: Tyler N.A. Winkelman, M.D., M.Sc., of Hennepin Healthcare, Minneapolis, Minnesota, and coauthors

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamanetworkopen.2018.0558)

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 emailmediarelations@jamanetwork.org.

Cost-Effectiveness Study of Risk-Based Screenings for Breast Cancer

Posted July 2, 2018 by Deanna Bellandi

JAMA Oncology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, JULY 5, 2018

Media advisory: To contact corresponding author Nora Pashayan, M.D., Ph.D., email npashayan@ucl.ac.uk. The full study is available on the For The Media website.

Want to embed a link to this study in your story?: Links will be live at the embargo time http://jamanetwork.com/journals/jamaoncology/fullarticle/10.1001/jamaoncol.2018.1901

Bottom Line: A cost-effectiveness study used a hypothetical group of women in the United Kingdom to compare risk-based breast cancer screening programs with a standard age-based screening program and no screening. Analysis was done from the perspective of the National Health Service.

Authors: Nora Pashayan, M.D., Ph.D., of University College London, England, and coauthors

Related Material: A podcast and editorial, “Implementation Challenges for Risk-Stratified Screening in the Era of Precision Medicine,” by Megan C. Roberts, Ph.D., of the National Cancer Institute, Rockville, Maryland, also are available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jamaoncol.2018.1901)

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.

# # #

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

Change in Use of ICD’s After Department of Justice Announces Investigation into Potential Overuse

Posted June 28, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 3, 2018

Media advisory: To contact corresponding author Jeptha P. Curtis, M.D., email Ziba Kashef at ziba.kashef@yale.edu. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.8151

Bottom Line: A U.S. Department of Justice investigation into the placement of implantable cardioverter-defibrillators (ICDs) in Medicare patients who didn’t qualify for them based upon Medicare coverage criteria was associated with significant decreases in the use of the devices that shock the heart to restore normal rhythm and in the proportion of devices not meeting these established criteria.

Why The Research Is Interesting: The Department of Justice (DOJ) announced in 2010 it was investigating hospitals under the False Claims Act for overusing ICDs in patients who didn’t meet criteria for Medicare reimbursement. The DOJ concluded its investigation in 2016 and reached settlements with more than 500 hospitals for more than $280 million.

Who and When: 300,151 ICDs implanted to prevent arrhythmia and sudden cardiac death in Medicare beneficiaries from 2007-2015 at 1,809 U.S. hospitals, of which 452 hospitals subsequently reached settlements with the DOJ.

What (Study Measures and Outcomes): DOJ investigation announcement in 2010 (exposure); proportion of ICDs not meeting Medicare coverage criteria (outcomes).

How (Study Design): This was an observational study. Researchers were not intervening for purposes of the study and cannot control for all the natural differences that could explain the study results.

Authors: Jeptha P. Curtis, M.D., Yale School of Medicine, New Haven, Connecticut, and coauthors

Results: The volume of ICDs and the proportion of devices not meeting Medicare coverage criteria decreased overall, and larger decreases were observed at hospitals that reached settlements with the DOJ.

Study Limitations: Analysis may not reflect all cases among non-Medicare beneficiaries and no public listing identifies all hospitals investigated by the DOJ.

Study Conclusions: The DOJ investigation was associated with significant declines in ICDs placed outside the National Coverage Determination at all hospitals, including patient populations that were not the focus of the investigation. The potential unintended consequences of the DOJ investigation warrant further study.

Related material: The editorial, “US Department of Justice Investigations of Implantable Cardioverter-Defibrillators and Quality Improvement in Health Care,” by Paul A. Heidenreich, M.D., M.S., Stanford University School of Medicine, Palo Alto, California, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.8151)

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.

Fetal Folic Acid Exposure Through Population-Wide Fortification of Grains and Brain Development

Posted June 28, 2018 by Deanna Bellandi

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 3, 2018

Media Advisory: To contact corresponding author Joshua L. Roffman, M.D., M.M.Sc., email Noah Brown at nbrown9@partners.org. The full study is available on the For The Media website.

Want to embed a link to this study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2018.1381

Bottom Line: Two decades ago, the U.S. government mandated grain products be enriched with folic acid to increase fetal exposure to reduce birth defects. This study examines whether increased fetal exposure to folic acid because of the mandated fortification of grains is associated changes in postnatal brain development, as measured by cortical thickness on magnetic resonance imaging (MRI) scans, and psychiatric risk in youth. MRIs from three groups of young people ages 8 to 18 were evaluated.

Authors: Joshua L. Roffman, M.D., M.M.Sc., of Massachusetts General Hospital, Harvard Medical School, Boston, and coauthors

Related Material: The editorial, “Investigating the Role of Micronutrients in Brain Development and Psychiatric Disorders via Magnetic Resonance Imaging,” by Tomas Paus, M.D., Ph.D., of the University of Toronto, Canada, also is available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/ jamapsychiatry.2018.1381)

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.

Finding Suggest HPV Testing Detects Cervical Pre-Cancer Earlier, More Accurately than Pap Smear

Posted June 28, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, JULY 3, 2018

Media advisory: To contact corresponding author Gina Suzanne Ogilvie, M.D., F.C.F.P., Dr.P.H., email Kevin Sauve of BC Cancer at kevin.sauve@bccancer.bc.ca or call 604-877-6436. The full study is available on the For The Media website.

Want to embed a link to this report in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.7464

Bottom Line: Nearly all cervical cancers are associated with persistent cervical infection from cancer-related human papillomavirus (HPV) strains. Testing for HPV alone, or combined with a Pap smear (cytology) for cervical screening, has been associated with increased detection of precancerous lesions compared with Pap smears alone. Some organizations have recommended primary HPV-based cervical cancer screening, while others have called for clinical trials of primary HPV testing alone. This study reports the results of a large randomized clinical trial of about 19,000 women that compared primary HPV testing alone versus Pap test for cervical screening. The study demonstrates that primary HPV testing of women detects precancerous lesions earlier, and more accurately than the Pap test. Furthermore, women who were HPV negative were less likely than women screened by Pap tests to have cervical pre-cancer after four years. More research is needed to understand the long-term outcomes and cost-effectiveness of HPV testing.

Authors: Gina Suzanne Ogilvie, M.D., F.C.F.P., Dr.P.H., University of British Columbia, Vancouver, Canada, and coauthors

Visual Abstract: JAMA is introducing this new feature initially focused on randomized clinical trials. A predictive link to the abstract that will work when the embargo lifts is here.

Related material: The editorial, “Replacing the Pap Test With Screening Based on Human Papillomavirus Assays,” by L. Stewart Massad, M.D., Washington University School of Medicine, St. Louis, Missouri, is also available on the For The Media website.

To Learn More: The full study is available on the For The Media website.

(doi:10.1001/jama.2018.7464)

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.