Millions of Google Searches For Sexual Harassment, Assault Since #MeToo

Posted December 19, 2018 by Deanna Bellandi

JAMA Internal Medicine

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

Media advisory: To contact study author John W. Ayers, Ph.D., M.A., email ayers.john.w@gmail.com. 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.2018.5094

Bottom Line: An estimated 40 to 54 million Google searches for sexual harassment and assault were recorded in the United States in the eight months after public accusations against film producer Harvey Weinstein and the ensuing #MeToo movement. Searches related to reporting and preventing such actions also were up based on the results of a study that monitored and analyzed search activity.

Authors: John W. Ayers, Ph.D., M.A., of the University of California, San Diego, and coauthors

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

(doi:10.1001/jamainternmed.2018.5094)

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.

Study Compares Scheduled vs. Emergency-Only Dialysis Among Undocumented Immigrants

Posted December 19, 2018 by Deanna Bellandi

JAMA Internal Medicine

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

Media advisory: To contact study author Oanh Kieu Nguyen, M.D., M.A.S., email Peter Farley at Peter.Farley@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.2018.5866

Bottom Line: A unique opportunity made it feasible for uninsured patients with end-stage renal disease (ESRD) who received emergency-only dialysis in Dallas, Texas, to enroll in private, commercial health insurance plans in 2015 and that made it possible for researchers to compare scheduled vs. emergency-only dialysis among undocumented immigrants with ESRD. This observational study included 181 undocumented immigrants, 105 of whom received insurance coverage and enrolled in scheduled dialysis and 76 of whom remained uninsured. Regularly scheduled dialysis (the standard of care for ESRD) compared with emergency-only dialysis (administered when a patient becomes life-threateningly ill) was associated with reductions in mortality, health care utilization and costs among patients with ESRD. The authors call for scheduled dialysis to be the standard of care for any patient with ESRD in the United States.

Authors: Oanh Kieu Nguyen, M.D., M.A.S., of the University of California, San Francisco, and coauthors

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

(doi:10.1001/jamainternmed.2018.5866)

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.

Is Program to Reduce Hospital Readmissions Associated With a Change in Patient Deaths?

Posted December 19, 2018 by Jim Michalski

JAMA

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

Media advisory: To contact corresponding author Robert W. Yeh, M.D., M.Sc., email Lindsey Diaz-MacInnis at ldiaz2@bidmc.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.2018.19232

Bottom Line: The Hospital Readmissions Reduction Program (HRRP) was created under the Affordable Care Act and hospitals face financial penalties for higher-than-expected 30-day readmission rates for patients with heart failure, heart attack and pneumonia. Lower hospital readmission rates for those conditions have been associated with the program but it was unclear if the program was associated with a change in patient deaths. This observational study included 8 million Medicare hospitalizations for heart failure, heart attack and pneumonia before and after HRRP was implemented. Study results suggest implementation of the HRRP was associated with an increase in deaths within 30 days after discharge for hospitalization for heart failure and pneumonia but not for heart attack. More research is needed to understand if the increase in 30-day postdischarge mortality is a result of the program, considering a lack of association with mortality within 45 days of hospital admission.

Authors: Robert W. Yeh, M.D., M.Sc., Beth Israel Deaconess Medical Center, Boston, and coauthors

Related Material: The editorial, “Unintended Harm Associated With the Hospital Readmissions Reduction Program,” by Gregg C. Fonarow, M.D., Ronald Reagan UCLA Medical Center, Los Angeles, 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.2018.19232)

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.

Has Marijuana Use by Teens Changed in Washington State Since Legalization?

Posted December 19, 2018 by Jim Michalski

JAMA Pediatrics

FOR IMMEDIATE RELEASE: DECEMBER 19, 2018

Media advisory: To contact corresponding author Julia A. Dilley, Ph.D., M.E.S., email Kate Willson at kate.willson@multco.us. 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.2018.4458

Bottom Line: Washington state legalized retail marijuana for adults 21 and older in 2012. Understanding how this change affects teens is important. This study assessed whether findings about marijuana use by young people in a Washington state-based youth survey were consistent with findings from a nationally representative survey. An analysis of the two surveys of students in the eighth, 10th and 12th grades finds differing results on whether marijuana use has increased or decreased among teens. The results of one survey suggest use declined after legalization among eighth and 10th graders; the other survey suggests an increase in use among 10th graders. Neither survey showed changes in use among 12th graders. Differences between the surveys in design and methods may explain the findings.

Author: Julia A. Dilley, Ph.D., M.E.S., Multnomah County/Oregon Public Health Division, Portland, and coauthors

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

(doi:10.1001/jamapediatrics.2018.4458)

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

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

Study Looks at ED Visits to Examine Opioid Prescribing in Pediatric Patients

Posted December 18, 2018 by Deanna Bellandi

JAMA Network Open

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

Media advisory: To contact corresponding study author Daniel M. Tomaszewski, Pharm.D., Ph.D., email Bethanie Le at bele@chapman.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.2018.6161

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: Opioids for pain management in pediatric patients are sometimes necessary but their use has raised concerns about the effects of opioids and later abuse. This analysis examined opioid prescribing rates using information from the National Hospital Ambulatory Medical Care Survey from 2006 to 2015 on more than 69,000 emergency department visits for patients younger than 18. Prescribing rates decreased from 8.2 percent in 2006–2010 to 6.3 percent in 2011–2015. Prescribing seemed to vary by region of the country, race, age and payment. For example, opioid prescribing rates were higher in the West; white patients and patients 13 to 17 were more likely to get prescriptions; and patients using Medicaid were less likely to get opioid prescriptions. The results of this observational study suggest inconsistencies in opioid prescribing requiring further research.

Authors: Daniel M. Tomaszewski, Pharm.D., Ph.D., Chapman University, Irvine, California, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.6161)

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.

Visual Abstract: Association Between 6-Week Postdischarge Risk Classification and 12-Month Outcomes After Orthopedic Trauma

Posted December 17, 2018 by Jim Michalski

How Common is Hepatitis C Infection in Each U.S. State?

Posted December 18, 2018 by Deanna Bellandi

JAMA Network Open

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

Media advisory: To contact corresponding study author Eli S. Rosenberg, Ph.D., email Kelsey Butz at kebutz@albany.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.2018.6371

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: Hepatitis C virus infection is a major cause of illness and death in the United States and injection drug use is likely fueling many new cases. This study, which used survey and vital statistics data, suggests about 1 percent of adults (0.93 percent) were living with hepatitis C from 2013 to 2016, and how common infections were varied by state and region. Nine states accounted for about 52 percent of all people living with hepatitis C (California, Texas, Florida, New York, Pennsylvania, Ohio, Michigan, Tennessee and North Carolina). The highest rates of infection were frequently in states heavily impacted by the opioid crisis, with 5 of 9 states with the highest number of hepatitis C infections in the Appalachian region. The results of this observational study could help to guide state-level prevention and treatment efforts because the resources necessary will vary by jurisdiction.

Authors: Eli S. Rosenberg, Ph.D., University at Albany School of Public Health, State University of New York, Rensselaer, New York, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.6371)

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

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

Listen to the Podcast: Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013

Posted December 17, 2018 by Jim Michalski

Listen to an interview with Robert A. Tessler, M.D., M.P.H., and Frederick P Rivara, M.D., M.P.H., co-authors of the JAMA Surgery study, “Trends in Firearm Injury and Motor Vehicle Crash Case Fatality by Age Group, 2003-2013.” The podcast is available for listening and download on this page.

Visual Abstract

Study Examines Head Impacts, Changes in Eye Function in H.S. Football Players

Posted December 18, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, DECEMBER 20, 2018

Media advisory: To contact corresponding author Keisuke Kawata, Ph.D., email April Toler at artoler@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/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.6193

Bottom Line: Head impacts in youth sports, even when they don’t cause symptoms of concussion, are a public health concern because these so-called subconcussive head impacts may result in long-term neurological issues if they are sustained repeatedly. This study looked at changes in measurements of near point of convergence (NPC), which is the distance from your eyes to where both eyes can focus without double vision, in 12 high school football players at 14 different times during a season. The NPC measurement matters because it has been shown to detect damage to neurons before symptoms appear. The frequency and magnitude of head impacts from all practices and games also were measured. Study findings suggest NPC values worsened with subconcussive head impacts, and that impaired NPC didn’t rapidly recover. However, NPC values began to return to normal in midseason while players continued to incur head impacts, suggesting the system controlling eye movements may develop tolerance to recurrent subconcussive head impacts. The findings of this study may not be generalized because of its small size.

Author: Keisuke Kawata, Ph.D., Indiana University, Bloomington, and coauthors

Related Material: The commentary, “Assessing Subconcussive Head Impacts in Athletes Playing Contact Sports – The Eyes Have It,” by Ann C. McKee, M.D., and Michael L. Alosco, Ph.D., of the Boston University 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/jamaophthalmol.2018.6193)

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.

Study Analyzes Report Card Release Dates, Calls to Child Abuse Hotline

Posted December 13, 2018 by Deanna Bellandi

JAMA Pediatrics

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

Media advisory: To contact corresponding author Melissa A. Bright, Ph.D., email mbright@coe.ufl.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.2018.4346

Bottom Line: This study used a complex method to analyze report card release dates and cases of child physical abuse called into a hotline and verified by Florida’s child welfare agency for elementary school children during an academic year. In an analysis that included 1,943 cases of verified child physical abuse, calls that resulted in verified cases came in at a higher rate on Saturdays when report cards were released on Fridays. Possible reasons to explain why are speculative and require further study. The study is limited by its focus only on public school data and data only on physical abuse that resulted in calls to a state hotline.

Authors: Melissa A. Bright, Ph.D., of the University of Florida, Gainesville, and coauthors

Related Material: The editorial, “Corporal Punishment and Children’s Report Cards – Failing Our Children,” by Antoinette L. Laskey, M.D., M.P.H., M.B.A., of the University of Utah, Salt Lake 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/jamapediatrics.2018.4346)

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.

Opioids vs. Placebo, Nonopioid Alternatives for Chronic Noncancer Pain

Posted December 13, 2018 by Jim Michalski

JAMA

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

Media advisory: To contact corresponding author Jason W. Busse, D.C., Ph.D., email Veronica McGuire at vmcguir@mcmaster.ca. 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.2018.18472

Bottom Line: An estimated 50 million adults in the United States were living with chronic noncancer pain in 2016 and many of them were prescribed opioid medications, even though a clinical benefit is uncertain. This study combined the results of 96 randomized clinical trials with about 26,000 participants to compare opioids with placebo and nonopioid alternative pain medications for the treatment of chronic noncancer pain. Opioids were associated with small improvements in pain and physical functioning plus increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid pain medication alternatives suggest the benefit for pain and functioning may be similar but the quality of evidence from the studies wasn’t high. None of the studies provided rates of developing opioid use disorder.

Authors: Jason W. Busse, D.C., Ph.D., McMaster University, Hamilton, Ontario, Canada, and coauthors

Related Material

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

A summary video for this study is available to view on this page and to embed on your website by copying and pasting the HTML code below. To download the video, email mediarelations@jamanetwork.org for information.

The JAMA editorial, “Increasing Evidence for the Limited Role of Opioids to Treat Chronic Noncancer Pain,” by Michael A. Ashburn, M.D., M.P.H., and Lee A. Fleisher, M.D., of the University of Pennsylvania, Philadelphia.

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

(doi:10.1001/jama.2018.18472)

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.

Video embed code:

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Visual Abstract

Posted December 11, 2018 by Deanna Bellandi

Are Migraines Associated With Type 2 Diabetes Risk in Women?

Posted December 13, 2018 by Deanna Bellandi

JAMA Neurology

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

Media Advisory: To contact corresponding author Guy Fagherazzi, Ph.D., email guy.fagherazzi@gustaveroussy.fr. 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.2018.3960

Bottom Line: A study of French women suggests a lower risk of type 2 diabetes was observed among women who reported current migraines compared with women with no history of the painful headaches.

Why The Research Is Interesting: Migraine and type 2 diabetes are common conditions in women but an association between them remains unclear.

Who and What: A group of more 74,000 French women insured by a health plan that mostly covered teachers and who were followed up by questionnaire.

How (Study Design): This was an observational study. Researchers didn’t intervene for purposes of the study and they cannot control all the factors that could explain the study findings.

Authors: Guy Fagherazzi, Ph.D., of the Center for Research in Epidemiology and Population Health, Villejuif, France, and coauthors

Results:

Study Limitations: Potential reasons that could explain the observations by researchers are uncertain.

Study Conclusions: The results of this study could have implications on the understanding of the underlying causes of these two common conditions and more research is needed to understand potential reasons that could explain these findings.

Related Material: The editorial, “Potential Benefits of Migraine – What Is It Good For?” by Amy A. Gelfand, M.D., M.A.S., of the University of California, San Francisco, and a JAMA Neurology associate editor, and Elizabeth Loder, M.D., M.P.H., of Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, 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/jamaneurol.2018.3960)

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.

Using EHR-Linked Medication Reminders for Glaucoma Patients

Posted December 11, 2018 by Jim Michalski

JAMA Ophthalmology

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

Media advisory: To contact corresponding author Michael V. Boland, M.D., email Jianyi Nie at jnie4@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/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.6066

Bottom Line: Mobile device reminders have been associated with better medication adherence and linking reminders to patient electronic health records (EHRs) could potentially allow some oversight by clinicians. In this study, 100 patients (average age 65) agreed to set up electronic health record-linked reminders delivered via text or voice message for glaucoma medications for three months and were surveyed about the experience. Of the participants, 94 ultimately set up reminders and 89 completed follow-up. Of these patients, 74 percent reported the reminders were useful, 15 percent were neutral about them and 11 percent found them not useful. Most participants (81 percent) had help setting up reminders. The generalizability of these results and the effect on glaucoma outcomes remains unknown.

Author: Michael V. Boland, M.D., Johns Hopkins University School of Medicine, Baltimore, and coauthors

Related Material: The commentary, “Preliminary Steps to Address Glaucoma Medication Adherence,” by Paula Anne Newman-Casey, M.D., M.S., University of Michigan, Ann Arbor, and Jonathan S. Myers, M.D., Thomas Jefferson University, 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/jamaophthalmol.2018.6066)

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

Childbirth Delivery Methods and Risk of Incontinence, Overactive Bladder

Posted December 13, 2018 by Jim Michalski

JAMA

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

Media advisory: To contact corresponding author Joan L. Blomquist, M.D., email John Lazarou at jlazarou@gbmc.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.2018.18315

Bottom Line: Pelvic floor disorders such as urinary incontinence and pelvic organ prolapse (when one or more of the pelvic organs drop from their normal position) are associated with childbirth and affect millions of women in the United States. This study examined the risk of pelvic floor disorders based on the method of childbirth delivery among 1,500 women a decade or two after giving birth. Cesarean delivery compared with spontaneous vaginal delivery was associated with less risk of stress urinary incontinence, overactive bladder and pelvic organ prolapse. An operative vaginal delivery, such as using forceps or one that is vacuum-assisted, was associated with higher risk of anal incontinence and pelvic organ prolapse. The data for the study were from a single hospital so the results may not be generalized to all populations.

Authors: Joan L. Blomquist, M.D., Greater Baltimore Medical Center, Maryland, and coauthors

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

(doi:10.1001/jama.2018.18315)

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.

Antipsychotic Treatment and Risk of Unexpected Death in Children, Young People

Posted December 10, 2018 by Jim Michalski

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, DECEMBER 12, 2018

Media advisory: To contact corresponding author Wayne A. Ray, Ph.D., email Craig Boerner at craig.boerner@vumc.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.2018.3421

Bottom Line: Antipsychotic medications can have adverse effects, including those that are life-threatening. This observational study examined the association of antipsychotic medications prescribed for children and young adults without psychosis and risk of unexpected death, which includes deaths due to unintentional drug overdose or cardiovascular/metabolic causes. About 250,000 children and young people (ages 5 to 24) enrolled in Medicaid in Tennessee were included. They were new users of antipsychotic medications who received higher or lower doses and new users of control medications that weren’t antipsychotics for comparison. An increased risk of unexpected death was associated with the group of patients who received a higher dose of antipsychotic medication compared with those who didn’t. Other factors could explain the differences between users of antipsychotics and control medications. These findings appear to reinforce careful prescribing and monitoring of antipsychotic medications in children and young people.

Authors: Wayne A. Ray, Ph.D., Vanderbilt University School of Medicine, Nashville, Tennessee, and coauthors

Related Material: The editorial, “Antipsychotics, Excess Deaths, and Paradoxes of Child Psychiatry,” by Barbara Geller, M.D., Washington University in St. Louis, 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.2018.3421)

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.

Is Early Physical Therapy Associated With Less Opioid Use in Patients With Musculoskeletal Pain?

Posted December 11, 2018 by Deanna Bellandi

JAMA Network Open

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

Media advisory: To contact corresponding study author Eric Sun, M.D., Ph.D., email Amy Jeter Hansen at ajeterhansen@stanford.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.2018.5909

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 use of early physical therapy in a study of nearly 89,000 U.S. adults with musculoskeletal pain of the shoulder, neck, knee and low back was associated with a lower likelihood of subsequent opioid use in an analysis of health insurance claims from 2007 to 2015. For patients who did use opioids, early physical therapy was associated with reduced opioid use for shoulder, knee and low back pain but not neck pain. The findings suggest early physical therapy may play a role in reducing the risk of subsequent long-term opioid use by patients with musculoskeletal pain. This was an observational study so other potential mitigating factors could help to explain the results.

Authors: Eric Sun, M.D., Ph.D., Stanford University School of Medicine, Stanford, California, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.5909)

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.

Characteristics of Physicians Excluded from Public Insurance Programs

Posted December 11, 2018 by Deanna Bellandi

JAMA Network Open

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

Media advisory: To contact corresponding study author Alice Chen, Ph.D., M.B.A., M.Sc., email Jenesse Miller at jenessem@usc.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.2018.5805

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: This study examined the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health care crimes or unlawful prescribing of controlled substances. There were 2,222 physicians (0.3 percent) excluded temporarily or permanently between 2007 and 2017 based on federal data. Exclusion rates were highest in the West and Southeast, with West Virginia having the highest exclusion rate at almost 6 per 1,000 physicians (32 exclusions among 5,720 physicians). Overall, physicians were more likely to be excluded if they were male, had osteopathic training, were older or practiced in specific specialties (family medicine, psychiatry, internal medicine, anesthesiology, surgery and obstetrics/gynecology). The study design prevents causal inferences but may help to identify characteristics associated with physicians more or less likely to engage in fraud.

Authors: Alice Chen, Ph.D., M.B.A., M.Sc., University of Southern California, Los Angeles, California, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.5850)

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.

Study Examines Risk of Stroke by Sex Among Black and White Women, Men

Posted December 6, 2018 by Deanna Bellandi

JAMA Neurology

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

Media Advisory: To contact corresponding author Virginia J. Howard, Ph.D., email Holly Gainer at hgainer@uab.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.2018.3862

Bottom Line: This study examined the risk of stroke by sex among more than 25,000 black and white women and men. White women had lower risk of stroke than white men and black women had lower risk than black men between the ages of 45 and 64; from 65 to 74 white women still had lower risk than white men but that difference didn’t persist among black women and men; and there was no difference by sex for either race at age 75 and older. The association of some risk factors with stroke risk also differed by sex for white women and men but not for black women and men. Study participants may not be representative of the general population. The findings suggest earlier and more aggressive management of risk factors may be warranted in some demographic groups to try to prevent stroke.

Authors: Virginia J. Howard, Ph.D., 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/jamaneurol.2018.3862)

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.

Are Suicidal Thoughts, Attempts More Likely in People With Eczema?

Posted December 10, 2018 by Jim Michalski

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, DECEMBER 12, 2018

Media advisory: To contact corresponding author April W. Armstrong, M.D., M.P.H., email Cynthia Smith at Cynthia.Smith@med.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/jamadermatology/fullarticle/10.1001/jamadermatol.2018.4566

Bottom Line: Eczema (atopic dermatitis) is a chronic inflammatory skin disease that affects millions of adults and children and has been associated with depression and anxiety. Evidence on the association between eczema and suicidal thoughts or attempts has been inconclusive. This study evaluated the association between eczema and suicidal thoughts and attempts by analyzing the combined results of 15 studies including 310,000 patients with eczema and 4.4 million people without eczema. The findings suggest patients with eczema were more likely to have suicidal thoughts and attempts compared to people without eczema. Data on completed suicides were limited and had inconsistent results.

Authors: April W. Armstrong, M.D., M.P.H., University of Southern California Keck School of Medicine, Los Angeles, and coauthors

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

(doi:10.1001/jamadermatol.2018.4566)

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.

Estimates of ASD, ADHD Risk in Siblings Born After Older Children With Those Disorders

Posted December 6, 2018 by Deanna Bellandi

JAMA Pediatrics

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

Media advisory: To contact corresponding author Meghan Miller, Ph.D., email Dorsey Griffith at dgriffith@ucdavis.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.2018.4076

Bottom Line: Siblings born in a family after other children with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) were more likely to be diagnosed with the same disorder or the other disorder.

Why The Research Is Interesting: ADHD and ASD are common neurodevelopmental disorders that likely share some genetic factors and biological influences. Estimating recurrence risk in families is a way to measure shared genetic factors. Such risk estimates are often based on the total number of siblings in a family rather than being limited to later-born siblings (those born after children with ASD or ADHD) so that risk can be underestimated if families decide to stop having children after a child develops ASD or ADHD. This study focused on risk for later-born siblings.

Who and What: A total of 15,175 later-born siblings classified by familial risk based on an older child’s diagnosis: ADHD risk (730), ASD risk (158) and no known risk (14,287); data were extracted from two large health care system in the United States.

How (Study Design): This was a population-based study.

Authors: Meghan Miller, Ph.D., of the University of California Davis Health System, Sacramento, California, and coauthors

Results:

Study Limitations: These include a selective sample, lack of information on half- or full-sibling status, and data drawn from general medical records.

Study Conclusions:

Related Material: The editorial, “Later Sibling Recurrence of Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder: Clinical and Mechanistic Insights,” by Tony Charman, Ph.D., of King’s College London, and Emily J.H. Jones, Ph.D., of the University of London, both in the United Kingdom, 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.2018.4076)

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.

Do Negative Public Attitudes Toward Weight Loss Surgery Stop Some Patients From Having Surgery?

Posted December 10, 2018 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, DECEMBER 12, 2018

Media advisory: To contact corresponding author Heather Yeo, M.D., M.H.S., email Krystle Lopez at krl2003@med.cornell.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.2018.4650

Bottom Line: Most patients who qualify for weight loss surgery don’t have the procedure despite its safety and effectiveness. One reason may be negative public attitudes toward weight loss surgery. This study assessed attitudes toward weight loss surgery with a national survey that included about 950 respondents. Nearly half reported they thought most people who had weight loss surgery did it for cosmetic reasons and about 40 percent thought people who had weight loss surgery chose the “easy way out.” Women were more likely to think most weight loss surgical procedures were performed for health reasons and less likely to think of surgery as an easy way out. The association between more negative attitudes about weight loss surgery and people not opting for it supports the suggestion that public attitudes may be at least partly responsible for the low use of weight loss surgical procedures.

Authors: Heather Yeo, M.D., M.H.S., New York-Presbyterian Hospital, Weill Cornell Medicine, New York, and coauthors

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

(doi:10.1001/jamasurg.2018.4650)

Editor’s Note: 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.

Ultrarestrictive Opioid Prescribing Strategy Associated With Fewer Pills Dispensed

Posted December 4, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, DECEMBER 7, 2018

Media advisory: To contact corresponding study author Emese Zsiros, M.D., Ph.D., email Annie Deck-Miller at annie.deck-miller@roswellpark.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.2018.5452

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 ultrarestrictive opioid prescribing strategy was associated with a reduction in the number of pills dispensed in a study of patients having surgery for gynecologic cancer, without changes in postoperative pain scores, complications or increases in prescription refill requests. Under the protocol, patients having ambulatory or minimally invasive surgery weren’t prescribed opioids at discharge unless they required more than five doses of oral or intravenous opioids while in the hospital. Surgical patients who had an abdominal incision (laparotomy) were given a three-day supply of opioids when they were discharged. The average number of opioid pills dispensed at discharge decreased after the ultrarestrictive prescribing protocol was implemented from 43.6 to 12.1 for patients who had a laparotomy; from 38.4 to 1.3 for patients who had minimally invasive surgery; and from 13.9 to 0.2 for patients who had ambulatory surgery. The findings reveal a promising strategy for decreasing postoperative opioid prescribing without increasing pain.

Authors: Emese Zsiros, M.D., Ph.D., Roswell Park Comprehensive Cancer Center, Buffalo, New York, and coauthors

Related Material: The invited commentary, “Striving for Evidence-Based Postoperative Opioid Prescribing While Optimizing Perioperative Pain Management—Shifting to Conservative Prescribing,” by Jennifer M. Hah, M.D., M.S., Stanford University, Palo Alto, California, also is available on the For The Media website.

Visual Abstract:

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

(doi:10.1001/jamanetworkopen.2018.5452)

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.

How Common Are Food Allergies?

Posted January 2, 2019 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, JANUARY 4, 2019

Media advisory: To contact corresponding study author Ruchi S. Gupta, M.D., M.P.H., email Vita Lerman at VLerman@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/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.5630

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: Survey data suggest at least 1 in 10 U.S. adults are food allergic and nearly 1 in 5 believe they have a food allergy. Food allergies are expensive and potentially life-threatening conditions. In this nationally representative survey study of more than 40,000 U.S. adults, nearly half of food-allergic adults developed allergies during adulthood, many reported being allergic to multiple foods, and 38 percent reported at least one food allergy–related emergency department visit in their lifetime. Shellfish allergy was the most common, followed by milk, peanut, tree nut and fin fish. Self-reported food allergies by study participants weren’t confirmed by diagnosis.

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

Visual Abstract

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

(doi:10.1001/jamanetworkopen.2018.5630)

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.

Visual Abstract: Association of Prevalence of Benign Disease After Partial Nephrectomy With Preoperative Imaging Patterns

Posted December 3, 2018 by Jim Michalski

Below is a visual abstract for the December 5 JAMA Surgery study, “Association of Prevalence of Benign Pathologic Findings After Partial Nephrectomy With Preoperative Imaging Patterns in the United States From 2007 to 2014,” by Jae Heon Kim, M.D., Ph.D., Soonchunhyang University Seoul Hospital, Seoul, South Korea and coauthors.

Are Infections Associated With Increased Risk of Later Mental Disorders During Childhood, Adolescence?

Posted December 3, 2018 by Deanna Bellandi

JAMA Psychiatry

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

Media Advisory: To contact corresponding author Ole Köhler-Forsberg, M.D., email karkoe@rm.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/jamapsychiatry/fullarticle/10.1001/jamapsychiatry.2018.3428

Bottom Line: This study used Danish nationwide registries to investigate an association between infections treated since birth and subsequent risk of treated childhood and adolescent mental disorders. Among nearly 1.1 million people born in Denmark between 1995 and 2012, about 42,000 (3.9 percent) were hospitalized for any mental disorder and nearly 57,000 (5.2 percent) redeemed a prescription for psychotropic medication. Infections requiring hospitalization were associated with subsequent increased risk of hospitalization for any mental disorder and increased risk of psychotropic medication use. Infections treated with medication, especially antibiotics, were associated with increased risk. Risks differed among mental disorders. Schizophrenia spectrum disorders, obsessive-compulsive disorder, personality and behavior disorders, mental retardation, autism spectrum disorder, attention-deficit/hyperactivity disorder, oppositional defiant disorder and conduct disorder, and tic disorders were associated with the highest risks after infections. This is an observational study and other factors might explain the results including the consequences of infections on the developing brain and other influences such as genetics and disturbances of the gut biome.

Authors: Ole Köhler-Forsberg, M.D., of Aarhus University Hospital, Denmark, and coauthors

Related Material: The editorial, “Harbingers of Mental Disease – Infections Associated With an Increased Risk for Neuropsychiatric Illness in Children,” by Viviane Labrie, Ph.D., and Lena Brundin, M.D., Ph.D., of the Van Andel Research Institute, Grand Rapids, Michigan, 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.2018.3428)

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.

Cardiac Surgery for Patients with Persistent Opioid Use Associated with Higher Rate of Complications, Increased Costs

Posted December 3, 2018 by Jim Michalski

JAMA Surgery

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

Media advisory: To contact corresponding author Edward G. Soltesz, M.D., M.P.H., email Andrea Pacetti at PACETTA@ccf.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/jamasurgery/fullarticle/10.1001/jamasurg.2018.4608

Bottom Line: Persistent use of opioids by patients is a public health concern in the United States but not much is known about the effect of that use on patients undergoing cardiac surgery. This observational study included 5.7 million patients who underwent cardiac surgery and it compared outcomes among those with persistent opioid use or dependence and those patients without. Researchers report no significant difference in the rate of death between the two groups of patients, although patients with persistent opioid use or dependence had a higher number of complications overall, longer length of hospital stay and higher costs. Limitations of the study include the possibility that opioid overuse disorders were underreported and that the definitions of opioid dependence or persistent opioid use weren’t consistent between hospitals.

Visual Abstract

Authors: Edward G. Soltesz, M.D., M.P.H., Cleveland Clinic Foundation, Cleveland, Ohio, and coauthors

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

(doi:10.1001/jamasurg.2018.4608)

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.

How Common is Autism Spectrum Disorder and Do Kids Receive Treatment?

Posted November 29, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, DECEMBER 3, 2018

Media advisory: To contact corresponding 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? Link will be live at the embargo time http://jamanetwork.com/journals/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.4208

Bottom Line: National survey data for 43,000 U.S. children suggests an estimated 2.8 percent have ever been diagnosed with autism spectrum disorder (ASD) and 2.5 percent currently have ASD. Among 1,115 children with current ASD, almost 30 percent aren’t treated with behavioral therapies or medication. ASD is a neurodevelopmental disorder marked by social impairments, communication difficulties, repetitive behaviors and restricted interests. Symptoms of ASD are often treated with behavioral therapies and medications. Among children with ASD who were treated, almost 64 percent received behavioral treatment and 27 percent received medication. In the study, which used data from the 2016 National Survey of Children’s Health, the frequency of ASD among children varied by state. The study has limitations, including that physician diagnoses of ASD were self-reported by parents. Understanding why some children with ASD don’t receive treatment is important.

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

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

(doi:10.1001/jamapediatrics.2018.4208)

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.

Are Opioids Prescribed by Dental Providers Associated With Later Use, Abuse?

Posted November 29, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, DECEMBER 3, 2018

Media advisory: To contact study author Alan R. Schroeder, M.D., email Erin Digitale at digitale@stanford.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.2018.5419

Bottom Line: An analysis of claims data for privately insured adolescents and young adults suggests initial exposure to opioids prescribed by dental providers may be associated with increased risk of subsequent opioid use and abuse. Dentists are a leading source of opioid prescriptions for children and adolescents. This observational study examined outpatient opioid prescriptions for patients 16 to 25 in 2015 because that’s the common age when third molars show up and are extracted. Included in the study were 14,888 people in an opioid-exposed group because they had filled an opioid prescription from a dental provider and 29,776 in a control group not exposed to opioids. The study relied on diagnosis codes so some misclassification may have happened and the results may not be generalized to other insured patients. The study concludes that more scrutiny of third-molar extractions and opioid prescriptions associated with postoperative care is needed.

Authors: Alan R. Schroeder, M.D., of Stanford University School of Medicine, Stanford, California, and coauthors

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

(doi:10.1001/jamainternmed.2018.5419)

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.

Patients Report Skimping on Insulin Because of Cost

Posted November 29, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, DECEMBER 3, 2018

Media advisory: To contact study author Kasia J. Lipska, 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 study in your story? Links will be live at the embargo time http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.5008

Bottom Line: In a small survey of patients at an urban diabetes center, 1 in 4 reported skimping on their prescribed insulin because of cost and this was associated with poor glycemic control. Insulin is lifesaving for people with diabetes and is listed as an essential medicine by the World Health Organization, which means that it should be available at a price individuals and the community can afford. Insulin prices have increased substantially in the past decade in the United States and so have out-of-pocket prescription costs. Of the 199 patients with type 1 or type 2 diabetes who were prescribed insulin and who completed the survey, 51 (25.5 percent) reported cost-related underuse of insulin. Underuse included using less than prescribed, trying to stretch out insulin, smaller doses, stopping insulin, not filling a prescription or not starting prescribed insulin. More than a third of the patients with cost-related underuse didn’t discuss the matter with their doctor. The single-center study may be limited in its broader ability to be generalized but researchers conclude the results highlight an urgent need to address the affordability of insulin.

Authors: Kasia J. Lipska, M.D., M.H.S., of the Yale School of Medicine, New Haven, Connecticut, and coauthors

Related Material: The invited commentary, “When High Prices Mean Needless Death,” by Elisabeth Rosenthal, M.D. , of Kaiser Health News, Washington, D.C., 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/jamainternmed.2018.5008)

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 Med School Diversity After Accreditation Standards Introduced

Posted November 29, 2018 by Jim Michalski

JAMA

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

Media advisory: To contact corresponding author Dowin H. Boatright, M.D., M.B.A., 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 study in your story? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.13705

Bottom Line: This observational study looked at changes in student makeup by sex, race and ethnicity at U.S. medical schools after an accrediting organization introduced diversity standards in 2009. An analysis of data from 120 medical schools suggests implementation of the diversity standards were associated with increasing percentages of female and black students. The study cannot demonstrate causality and other unaccounted factors could help explain the findings. Researchers noted the results are promising but that disparities persist in the diversity of the physician workforce.

Authors: Dowin H. Boatright, M.D., M.B.A., M.H.S., Yale 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.2018.13705)

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.

Study Estimates Proportion of Health Care Professionals Not Born in U.S.

Posted November 29, 2018 by Jim Michalski

JAMA

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

Media advisory: To contact corresponding author Anupam B. Jena, M.D., Ph.D., email Ekaterina Pesheva at Ekaterina_Pesheva@hms.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.2018.14270

Bottom Line: Health care professionals not born in the United States, including those who are noncitizens, made up a significant proportion of the health care workforce in 2016. An analysis of U.S. Census Bureau data for 164,000 health care professionals found 16.6 percent weren’t born in the United States and 4.6 percent were noncitizens. Non-U.S.-born health care professionals were a substantial proportions of several health care professions, including physicians (29 percent), dentists (24 percent), pharmacists (20 percent), registered nurses (16 percent) and nursing, psychiatric, and home health aides (23 percent). The majority of health care professionals not born in the United States were born in Asia (6.4 percent) or Mexico and Central America or the Caribbean (4.7 percent). The studied relied on survey-reported occupation and there was the possibility of underreporting of noncitizenship.

Authors: Anupam B. Jena, M.D., Ph.D., Harvard Medical School, Boston, and coauthors

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

(doi:10.1001/jama.2018.14270)

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.

Polio-Like Illness Mostly of Children is Focus of 3 JAMA Pediatrics Articles

Posted November 28, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 30, 2018

Media advisory: To contact corresponding author Matthew J. Elrick. M.D., Ph.D., email Vanessa McMains at vmcmain1@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/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.4890

Bottom Line: Acute flaccid myelitis (AFM) is a poorly understood polio-like illness mostly of children characterized by weakness of muscles and limbs and the presence of a spinal cord lesion. An increase in cases was first suspected in 2012 and some epidemiologic evidence suggests viruses may be associated with AFM outbreaks in the United States in the late summer and fall of 2014, 2016 and 2018. Much still needs to be learned about the cause, progression, biomarkers, prognosis and treatment of this rare condition.

JAMA Pediatrics published three new articles on AFM because of their clinical and public health importance:

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

(doi:10.1001/jamapediatrics.2018.4890)

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.

Results of Mass Screening of Children, Teens for Thyroid Cancer Following Fukushima Nuclear Accident

Posted November 27, 2018 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, NOVEMBER 29, 2018

Media advisory: To contact corresponding author Akira Ohtsuru, M.D., Ph.D., email ohtsuru@fmu.ac.jp. 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.2018.3121

Bottom Line: The accident at Japan’s Fukushima Daiichi nuclear power station in 2011 raised grave concerns about radioactive material released into the environment, including concerns over radiation-induced thyroid cancer. Ultrasound screenings for thyroid cancer were subsequently conducted in the Fukushima Health Management Survey. This observational study group includes about 324,000 people 18 or younger at the time of the accident and it reports on two rounds of ultrasound screening during the first five years after the accident. Thyroid cancer or suspected cancer was identified in 187 individuals within five years (116 people in the first round among nearly 300,000 people screened and 71 in the second round among 271,000 screened). The overwhelmingly common diagnosis in surgical cases was papillary thyroid cancer (149 of 152 or 98 percent).

Authors: Akira Ohtsuru, M.D., Ph.D., Fukushima Medical University, Fukushima, Japan, and coauthors

Related material: The commentary, “Why the Data From the Fukushima Health Management Survey After the Daiichi Nuclear Power Station Accident Are Important,” by Andrew J. Bauer, M.D., University of Pennsylvania, Philadelphia, and Louise Davies, M.D., M.S., Department of Veterans Affairs Medical Center, White River Junction, Vermont, 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/jamaoto.2018.3121)

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

# # #

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

Do Poorer Neighborhoods Experience Longer Ambulance Times?

Posted November 27, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 30, 2018

Media advisory: To contact corresponding 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.2018.5202

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: Patients from the poorest neighborhoods who had cardiac arrest had longer total ambulance times than those from the wealthiest neighborhoods.

Why The Research Is Interesting: Emergency medical services (EMS) provide critical care before patients reach the hospital and differences in ambulance times may contribute to disparities in patient outcomes.

What and When: National data from 46 states on 63,600 patients who had cardiac arrest and didn’t die on scene and were transported to a hospital

What (Study Measures and Outcomes): Four time measures were examined (response time, on-scene time, transport time and total EMS time) and compared with EMS response time benchmarks for responding to cardiac arrest calls.

How (Study Design): This was an observational study. Researchers weren’t 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., University of California, San Francisco, and coauthors

Results:

Study Limitations: The registry analyzed for this study wasn’t of individual patients so multiple reports associated with the same patient exist; other explanations beyond the variables assessed in this study may have contributed to time disparities; and the findings may not be generalized to other types of time-sensitive EMS calls.

Study Conclusions:

Related Material: The invited commentary, “Income and Ambulance Response Time Inequality—No Simple Explanation, No Simple Fix,” by Andrew I. Friedson, Ph.D., University of Colorado Denver, also is available on the For The Media website.

Visual Abstract: This visual abstract 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.2018.4945)

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.

Do Magazine-Ranked Hospitals for Cardiovascular Care Have Better Outcomes?

Posted November 26, 2018 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, NOVEMBER 28, 2018

Media advisory: To contact corresponding author Deepak L. Bhatt, M.D., M.P.H., email Johanna Younghans at jyounghans@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/jamacardiology/fullarticle/10.1001/jamacardio.2018.3951

Bottom Line: Whether hospital rankings by U.S. News & World Report magazine reflect quality of care has been debated. This study examined if the magazine’s 50 top-ranked hospitals for cardiovascular care performed better than 3,500 non-ranked hospitals on death rates and hospital readmissions for three cardiovascular conditions, as well as patient satisfaction. Researchers report top-ranked hospitals did have lower 30-day mortality rates for heart attack, heart failure and coronary artery bypass grafting (CABG) and higher patient satisfaction ratings compared with non-ranked hospitals. However, 30-day readmission rates were either similar (for heart attack and CABG) or higher (for heart failure) at the top-ranked hospitals compared with non-ranked hospitals. The discrepancy between readmissions and other measures raises concern that readmissions may not be an adequate metric of hospital care quality. A limitation of the study was that the rankings only include data from Medicare patients.

Authors: Deepak L. Bhatt, M.D., M.P.H., Brigham and Women’s Hospital, Harvard Medical School, Boston, and coauthors

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

(doi:10.1001/jamacardio.2018.3951)

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 email mediarelations@jamanetwork.org.

What Are Effects of Smoked, Vaporized Marijuana in Infrequent Adult Users?

Posted November 27, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 30, 2018

Media advisory: To contact corresponding study author Ryan Vandrey, Ph.D., email Vanessa McMains at vmcmain1@jhmi.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.2018.4841

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 compared the effects of smoked versus vaporized cannabis at two different doses and a placebo dose in a small study of 17 healthy adults who weren’t regular cannabis users. Participants felt the effects of smoked and vaporized cannabis at a 10-mg dose of the psychoactive component THC, including modest cognitive impairment, while a 25-mg dose of THC produced more pronounced drug effects and substantial impairment of cognitive and psychomotor functioning. Vaporized cannabis produced stronger drug effects on users and higher blood concentrations of THC compared with equal doses of smoked cannabis. The study was limited by a small range of doses.

Authors: Ryan Vandrey, Ph.D., Johns Hopkins University School of Medicine, Baltimore, and coauthors

Related Material: The invited commentary, “Peering Through the Haze of Smoked vs Vaporized Cannabis—To Vape or Not to Vape?” by Nadia Solowij, Ph.D., University of Wollongong, Australia, 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.2018.4841)

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

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

Telemedicine Use Increases But Still Uncommon

Posted November 21, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 27, 2018

Media advisory: To contact corresponding author Michael L. Barnett, M.D., M.S., 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? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.12354

Bottom Line: Laws passed in 32 states promote the use of telemedicine by mandating coverage and reimbursement. Telemedicine is the remote evaluation, diagnosis and treatment of patients using electronic communication. In this study, claims data from a large, private U.S. health plan were analyzed to estimate the growth in telemedicine from 2005 to 2017. Researchers report telemedicine use increased substantially during those years but was still uncommon by 2017. Annual telemedicine visits among all members in this health plan increased from 0.020 to 6.57 per 1,000 members between 2005-2017, with the largest increases in use beginning in 2015. Most telemedicine users lived in urban areas, although the attention given to telemedicine is often to encourage its use in rural settings. These data are from a single insurer whose population and policies may not be generalized to other populations.

Authors: Michael L. Barnett, M.D., M.S., Harvard T. H. Chan School of Public Health, Boston, and coauthors

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

(doi:10.1001/jama.2018.12354)

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

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

Visual Abstract Available

Posted November 19, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, NOVEMBER 21, 2018

Media advisory: 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.2018.5147

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.

Visual abstract: The study, “Assessment of Incorrect Surgical Procedures Within and Outside the Operating Room,” is accompanied by the visual abstract below

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

Exposure to Police Violence Reported Often, Associated With Mental Health Issues

Posted November 19, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, NOVEMBER 21, 2018

Media advisory: To contact corresponding study author Jordan E. DeVylder, Ph.D., email Kylie Lacey at kylie@tvpcommunications.com. 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.2018.4945

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: Exposure to police violence is increasingly recognized as a public health issue in the United States. In this survey study of 1,000 adults in Baltimore, Maryland, and New York, New York, exposure to police violence was reported by many residents, especially those who were racial/ethnic and sexual minorities. The frequency of exposure to police violence over 12 months ranged from 3 percent for sexual violence (i.e. inappropriate sexual contact including during a body search) to 7.5 percent for physical violence without a weapon (i.e. hit, punched, dragged) and 4.6 percent for physical violence with a weapon (i.e. use of gun, baton, taser) to 13 percent for psychological violence (i.e. threats, intimidation, being stopped without cause) and nearly 15 percent for neglectful policing (i.e. police were called for help but never responded or responded too late or inappropriately). These exposures were associated with a greater likelihood of mental health issues, including psychological distress, suicidal thoughts, suicide attempts and psychotic experiences. The authors note causal inferences cannot be drawn from the findings and more research is needed to understand the effect over time of exposure to violence by police.

Authors: Jordan E. DeVylder, Ph.D., Fordham University, New York, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.4945)

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 Common Are Eating Disorders in Young Children?

Posted November 21, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 26, 2018

Media advisory: To contact corresponding author Aaron J. Blashill, Ph.D., email Cory Marshall at cory.marshall@sdsu.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.2018.3678

Bottom Line: The frequency of eating disorder diagnoses was low among U.S. children ages 9 to 10 in an analysis of data from another study. Across all eating disorder diagnoses, the overall frequency was 1.4 percent with no significant differences between girls and boys in a nationally representative group of 4,500 children 9 to 10 years old. The authors suggest sex differences in eating disorders may not emerge until later on in adolescence. In this group of children, the prevalence of anorexia nervosa was 0.1 percent, there were no cases of bulimia nervosa, the frequency of binge-eating disorder was 0.6 percent, and the prevalence of any other specified feeding and eating disorder diagnosis was 0.7 percent.

Authors: Aaron J. Blashill, Ph.D., of San Diego State University, San Diego, California, and coauthors

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

(doi:10.1001/jamapediatrics.2018.3678)

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.

Frequent Family Dinners Associated With Healthier Youth Diets No Matter How Well Family Functions

Posted November 19, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, NOVEMBER 21, 2018

Media advisory: To contact corresponding study author Kathryn Walton, Ph.D., R.D., email Deirdre Healey at healeyd@uoguelph.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.2018.5217

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 frequent family dinners were associated with more healthful eating by adolescents and young adults, regardless of the level of family functioning in managing daily routines, communicating and connecting emotionally. This study used data from 2,728 teenagers and young adults (14 to 24) living at home with their parents and included details on the frequency of family meals, foods eaten and levels of family functioning. Frequent family meals were associated with eating more fruits and vegetables and less fast food and takeout food for young people in both high-functioning and low-functioning families. The findings suggest family dinners are a good way to encourage more healthful eating in adolescents and young adults.

Authors: Kathryn Walton, Ph.D., R.D., University of Guelph, Ontario, Canada, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.5217 )

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.

USPSTF Recommendation Statement on Interventions to Prevent Child Maltreatment

Posted November 21, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 27, 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.2018.17772

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) finds limited or inconsistent evidence on the benefits of primary care interventions to prevent child maltreatment (defined as abuse, neglect or both). Children with signs or symptoms suggesting maltreatment should be assessed or reported according to applicable state laws.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement reaffirms its 2013 position that there is insufficient evidence on the benefits of primary care interventions to prevent child maltreatment. In 2016, approximately 676,000 children in the United States experienced maltreatment and more than 1,700 children died as a result.

The USPSTF Recommendation:

Related Material

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

— An interview with Alex R. Kemper, M.D., M.P.H., M.S., USPSTF member and coauthor of the recommendation statement. The transcript is available here.

— Interventions to Prevent Child Maltreatment – U.S. Preventive Services Task Force Recommendation Statement

— Primary Care Interventions to Prevent Child Maltreatment – Updated Evidence Report and Systematic Review for the U.S. Preventive Services Task Force

— JAMA editorial: Preventing Maltreatment of Children

— JAMA Patient Page: Interventions to Prevent Child Maltreatment

(doi:10.1001/jama.2018.17772)

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.

Study Estimates How Much Time Adults Sit, How Many Are Physically Inactive

Posted November 15, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 20, 2018

Media advisory: To contact corresponding author Emily N. Ussery, Ph.D., email CDC Media Relations at media@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/jama/fullarticle/10.1001/jama.2018.17797

Bottom Line: Sitting too long and being physically inactive can be bad for your health, and it’s important to understand how common these behaviors are among U.S. adults. This study used data from a nationally representative survey of about 5,900 adults to examine sitting time and leisure-time physical activity. Researchers report 1 in 4 adults sit for more than 8 hours a day, 4 in 10 are physically inactive with no moderate or vigorous activity during the week, and 1 in 10 reported both sitting more than 8 hours a day and being physically inactive. Limitations of the study include self-reported data. Practitioners can help support programs and policies that help adults sit less and move more.

Authors: Emily N. Ussery, Ph.D., Centers for Disease Control and Prevention, Atlanta, and coauthors

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

(doi:10.1001/jama.2018.17797)

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.

Association of Air Pollutant at Mothers’ Homes During Pregnancy, Risk of Autism Spectrum Disorder in Kids

Posted November 15, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 19, 2018

Media advisory: To contact corresponding author Lief Pagalan, M.Sc., email Ian Bryce at ian_bryce@sfu.ca. 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.2018.3101

Bottom Line: In a study of estimated exposure to air pollution at mothers’ homes during pregnancy, 1 of 3 airborne pollutants was associated with increased risk of autism spectrum disorder (ASD) in children in a Canadian metropolitan area with relatively low ambient air pollution levels. What causes ASD isn’t known but some previous research has suggested environmental contaminants and air pollution may be potential risk factors. This study included nearly all births in Vancouver, British Columbia, from 2004 through 2009. Among 132,256 births, 1 percent of children (1,307) were diagnosed with ASD by age 5. Of three pollutants, nitric oxide (NO) was positively associated with increased risk of ASD after accounting for other potential mitigating factors. NO was used as an indicator of traffic-related pollution. Other potential unaccounted factors could tamp down the study findings; direct assessment of air pollution exposure wasn’t possible; and the study cannot draw causal inferences.

Authors: Lief Pagalan, M.Sc., Simon Fraser University, British Columbia, Canada, and coauthors

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

(doi:10.1001/jamapediatrics.2018.3101)

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.

Firearms More Likely to be Stored Unsafely In Households if Adults Misuse Alcohol

Posted November 15, 2018 by Jim Michalski

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 19, 2018

Media advisory: To contact corresponding author Erin R. Morgan, M.S., email Barbara Clements at bac60@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/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.3624

Bottom Line: Firearm injuries and deaths among children are a public health issue. This study used telephone survey data from 5,200 people in Washington to describe how common firearms were in households with children in the state and to assess the association between children living in a home with a firearm stored unsafely and an adult who reported misusing alcohol. About 30 percent of children in the state lived in firearm-owning households and an estimated 55 percent of those children lived with a firearm not stored safely. Firearms were more likely to be stored unsafely in homes where an adult reported misusing alcohol. A limitation of the study is the likely underreporting of unsafe gun storage practices.

Authors: Erin R. Morgan, M.S., University of Washington, Seattle, and coauthors

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

(doi:10.1001/jamapediatrics.2018.3624)

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.

Dementia Associated With Most Deaths of Older Adults with Down Syndrome

Posted November 15, 2018 by Jim Michalski

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 19, 2018

Media Advisory: To contact corresponding author Rosalyn Hithersay, M.Sc., email rosalyn.hithersay@kcl.ac.uk. 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.2018.3616

Bottom Line: Older adults with Down syndrome are at increased risk for developing dementia. This study examined the effect of dementia on death rates in adults with Down syndrome in the United Kingdom. The study included 211 adults, of whom 66 had dementia with an average age at diagnosis of 52. Over the 5 ½-year study period, 27 adults died, 70 percent of whom had dementia, and their average age at death was 57. The study was limited by its small sample size. The high proportion of adults with Down syndrome who go on to develop dementia make this an important population for studying disease progression and potential treatments.

Authors: Rosalyn Hithersay, M.Sc., King’s College London, London, and coauthors

Related Material: The editorial, “Prevalence and Severity of Alzheimer Disease in Individuals With Down Syndrome,” by Michael S. Rafii, M.D., Ph.D., Keck School of Medicine of the University of Southern California, San Diego, and Stephanie L. Santoro, M.D., Massachusetts General Hospital and Harvard Medical School, Boston, 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/jamaneurol.2018.3616)

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

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

Is the Rise in Blood Pressure with Age a Consequence of the Western Lifestyle?

Posted November 12, 2018 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, NOVEMBER 14, 2018

Media advisory: To contact corresponding author Noel T. Mueller, Ph.D., M.P.H., 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? Link will be live at the embargo time http://jamanetwork.com/journals/jamacardiology/fullarticle/10.1001/jamacardio.2018.3676

Bottom Line: A common belief in cardiology is that blood pressure (BP) increases with age, although studies find little evidence of that among non-Western adults in isolated communities. But does the association between age and BP differ in two isolated communities with different levels of Westernization? In this study, researchers examined the association between age and BP in two communities in a remote area of the Venezuelan rainforest inaccessible by land. The Yanomami community is made up of hunter-gatherer-gardeners who are among the least assimilated people in the world. The Yekwana people live near the Yanomami but they have been exposed to missions and an airstrip has allowed for delivery of medicine and other features of Western lifestyle, including occasional exposure to processed foods and salt. Blood pressure measurements were taken for 72 Yanomami and 83 Yekwana participants between the ages of 1 and 60 over about five months. Researchers found no age-associated rise in BP in Yanomami children and adults, whereas there was an age-associated rise in BP in the more Western-exposed Yekwana community that began in childhood. These results add to findings that suggest the rise in BP with age may not be natural but rather a consequence of unnatural Western exposures. A limitation of the study was its small sample size.

Authors: Noel T. Mueller, Ph.D., M.P.H., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, and coauthors

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

(doi:10.1001/jamacardio.2018.3676)

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.

Intimate Partner Violence, Sexual Assault, PTSD Associated With Women’s Experience of Menopause

Posted November 15, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 19, 2018

Media advisory: To contact study author Carolyn J. Gibson, Ph.D., M.P.H., email Suzanne Leigh at Suzanne.Leigh@ucsf.edu v. 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.2018.5233

Bottom Line: A history of intimate partner violence or sexual assault and posttraumatic stress disorder (PTSD) symptoms are common among midlife and older women and are associated with women’s experience of menopause.

Why The Research Is Interesting: Violence against women is a public health problem. The general health and functioning of midlife and older women can be affected by common symptoms related to menopause and aging, including trouble sleeping, vasomotor symptoms such as hot flashes, and vaginal symptoms including dryness, irritation and pain during sex. How exposure to trauma and PTSD symptoms might be linked to the development and exacerbation of these common symptoms throughout the menopause transition is unclear.

Who and When: Multiethnic group of about 2,000 women between 40 and 80 in the Kaiser Permanente Northern California health care system; data analysis conducted from late 2008 to early 2012

What (Measures and Outcomes): Lifetime physical or emotional intimate partner violence (IPV), sexual assault, and current PTSD symptoms assessed through questionnaires (exposures); difficulty sleeping, vasomotor symptoms and vaginal symptoms assessed through questionnaires (outcomes)

How (Study Design): This was an observational study. Researchers weren’t intervening for purposes of the study and they cannot control natural differences that could explain the study findings.

Authors: Carolyn J. Gibson, Ph.D., M.P.H., of the San Francisco Veterans Affairs Health Care System, San Francisco, California, and coauthors

Results: About 1 in 5 women experienced IPV or sexual assault and nearly 1 in 4 had PTSD symptoms. A history of emotional IPV and PTSD symptoms were associated with difficulty sleeping, vasomotor symptoms and vaginal symptoms; a history of physical IPV was associated with night sweats; and sexual assault was associated with vaginal symptoms.

Study Limitations: Findings should be interpreted in the context of limitations of the data, including that they don’t allow for determinations to made about trends over time, the duration of menopause symptoms and traumatic exposures, or other associations between variables.

Study Conclusions:

Related Material: The invited commentary, “Association of Interpersonal Violence with Women’s Health,” by Rebecca C. Thurston, Ph.D., and Elizabeth Miller, M.D., Ph.D., of the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, 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.2018.5233)

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.

Weight History May Be Important for Determining Risk of Early Death

Posted November 13, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 16, 2018

Media advisory: To contact corresponding study author Ching-Ti Liu, Ph.D., and Andrew Stokes, Ph.D., email Meaghan Agnew at meaghans@bu.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.2018.4587

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 patient’s weight history could help identify those at increased risk of dying. Using data for nearly 6,200 people from the Framingham Heart Study, this study incorporated weight history to examine the association between obesity and risk of death because many studies typically rely on weight status at a single point in time. Researchers found an association between maximum body mass index (BMI) over 24 years of weight history and risk of death, with increasing risk for obese individuals compared to those who were normal weight. Maximum BMI in the normal-weight range was associated with the lowest risk of death, pointing to the importance of obesity prevention.

Authors: Ching-Ti Liu, Ph.D., Boston University School of Public Health, Boston, Massachusetts, and co-authors

Related Material: The invited commentary, “Long-Term Body Mass Index and Mortality in the Framingham Heart Study,” by Mark A. Pereira, Ph.D., University of Minnesota, Minneapolis, 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.2018.4587 )

Editor’s Note: The article contains funding/support and 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 email mediarelations@jamanetwork.org.

Are Recreational Marijuana Companies’ Social Media Posts Compliant with Regulations?

Posted November 13, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 16, 2018

Media advisory: To contact corresponding study author Megan A. Moreno, M.D., M.S.Ed., M.P.H., email Toni Morrissey at TMorrissey@uwhealth.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.2018.2242

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: Recreational marijuana use was legalized in the state of Washington in 2012 and there are regulations about posting product promotion messages on social media, while direct advertising of marijuana on social media remains illegal. Under state regulations, marijuana companies can’t advertise using language that promotes overconsumption, describes marijuana’s curative or therapeutic benefits, or is designed to appeal to youths. This study analyzed more than 1,000 posts on Facebook and Twitter from the business pages of six recreational marijuana companies in Washington state to see how often they adhered to state regulations. Most social media posts were consistent with state regulations but there were 17 posts (1.7 percent) that encouraged overconsumption; 137 posts (13.3 percent) that promoted therapeutic benefits; and nine posts (0.01 percent) that appealed to youth. Requirements for warnings addressing intoxication, driving, health risks and age restrictions were on 110 posts (10.7%).

Visual Abstract

Authors: Megan A. Moreno, M.D., M.S.Ed., M.P.H., University of Wisconsin-Madison, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.2242 )

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.

What is Value-Based Pricing Amount for Self-Injectable Epinephrine Devices?

Posted November 13, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 16, 2018

Media advisory: To contact corresponding study author Marcus Shaker, M.D., M.S., email Mike Barwell at Michael.R.Barwell@hitchcock.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.2018.4728

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: For children and adults with food allergies, personal self-injectable epinephrine devices are crucial to treating severe reactions such as anaphylaxis if there is unintended exposure to allergens. Autoinjectors have become very expensive, although the drug they inject is cheap. In this study of simulated children with peanut allergy, researchers estimated value-based pricing for the devices, which is a method of drug pricing where drug costs are based on the magnitude of the benefit they provide. This analysis suggests a value-based pricing model for autoinjectors at no more than $24 a year for children with peanut allergies to protect against risk of death.

Authors: Marcus Shaker, M.D., M.S., Dartmouth Geisel School of Medicine, Lebanon, New Hampshire, and Matthew Greenhawt, M.D., M.B.A., M.Sc., University of Colorado School of Medicine, Aurora, Colorado

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

(doi:10.1001/jamanetworkopen.2018.4728)

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.

Does Having ‘Lazy Eye’ Affect a Child’s Self-Esteem?

Posted November 13, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, NOVEMBER 15, 2018

Media advisory: To contact corresponding author Eileen E. Birch, Ph.D., email Vanessa Peterson at vpeterson@retinafoundation.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.2018.5527

Bottom Line: Academic performance, interactions with peers, and athletic ability are factors connected to self-esteem in school children. This study of children in the third to eighth grades looked at whether the condition “lazy eye” or amblyopia, where one eye has reduced vision due to misalignment or blur, was associated with lower self-perception by children of their competence, appearance, conduct and self-worth. The study included 50 children with amblyopia, along with 13 others without it but with misalignment or blur of one eye, and 18 children with no such eye conditions in a control group for comparison. Children with “lazy eye” had lower scholastic, social and athletic scores on a self-perception profile than the children in the control group. Reading speed was associated with self-perception of academic competence, while aiming and catching skills were associated with self-perception of scholastic, social and athletic ability for children with amblyopia. However, it is unknown if improvements in sensory function because of treatment for amblyopia will result in improved self-perception scores.

Authors: Eileen E. Birch, Ph.D., Retina Foundation of the Southwest, Dallas, and coauthors

Related Material: The commentary, “Childhood Self-Perceptions in Children With Amblyopia,” by Joseph L. Demer, M.D., Ph.D., University of California, Los Angeles, 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.2018.5527)

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

Summary Video: Effect of a Pharmacist-Led Intervention on Inappropriate Prescriptions in Older Adults

Posted November 8, 2018 by Jim Michalski

A summary video is available for the study, “Effect of a Pharmacist-Led Educational Intervention on Inappropriate Medication Prescriptions in Older Adults,” by Cara Tannenbaum, M.D., M.Sc., Université de Montréal, Quebec, Canada, and coauthors. The video can be viewed on this page and embedded on your website by copying and pasting the HTML code below. To download the video, email mediarelations@jamanetwork.org for information.

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=5858459784001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

Concussion Associated With Suicide Risk

Posted November 8, 2018 by Deanna Bellandi

JAMA Neurology

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 12, 2018

Media Advisory: To contact corresponding author Michael Fralick, M.D., S.M., email Heidi Singer at Heidi.Singer@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.2018.3487

Bottom Line: Experiencing concussions or mild traumatic brain injury (TBI) was associated with increased risk of suicide in a new analysis but the absolute risk was small because nearly all patients diagnosed with concussion or TBI didn’t die by suicide. Data from 17 studies for more than 700,000 patients diagnosed with concussion or mild TBI and more than 6.2 million people without such diagnoses were included in this 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. Researchers want more studies done to identify strategies to prevent concussions and mild TBI and to find ways to identify patients at highest risk of suicide after such injuries.

Authors: Michael Fralick, M.D., S.M., of the University of Toronto, Canada, and coauthors

Related Material: The editorial, “On the Link Between Concussions and Suicide,” by Donald A. Redelmeier, M.D., M.S.H.R., and Junaid A. Bhatti, M.B.B.S., M.Sc., 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/jamaneurol.2018.3487)

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.

Studies Examine Availability of Opioid-Overdose Antidote at Pharmacies

Posted November 8, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 13, 2018

Media advisory: To contact corresponding author Talia Puzantian, Pharm.D., BCPP, email Ivan Alber at ialber@kgi.edu. To contact corresponding author Kirk E. Evoy, Pharm.D., BCACP, BC-ADM, CTTS, email Nick Nobel at nobel@utexas.edu. The full studies are available on the For The Media website.

Want to embed a link to these studies in your story? Links will be live at the embargo time

Puzantian study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.12291

Evoy study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.15892

Bottom Line: Two studies looked at the availability of naloxone, an antidote for opioid overdoses, from pharmacies in two states that have passed legislation to allow pharmacists to dispense the medication without a physician’s prescription.

What: Having access to naloxone can reduce the risk of death from an opioid overdose. Legislation in California has allowed trained pharmacists to provide naloxone without a physician’s prescription since 2016. In this study, an anonymous telephone survey of some California community pharmacies was conducted in 2018 with interviewers posing as potential customers who asked pharmacy staff if they could get naloxone without a prescription. Less than 25 percent of about 1,150 retail pharmacies said they were giving naloxone to patients without a physician prescription. Of the pharmacies providing the medication, only about 50 percent had nasal naloxone in stock. Limitations of the study include a lack of data on the reasons why pharmacies weren’t providing the naloxone.

Authors: Talia Puzantian, Pharm.D., BCPP, Keck Graduate Institute School of Pharmacy and Health Sciences, Claremont, California, and James J. Gasper, Pharm.D., BCPP, University of California, San Francisco

(doi:10.1001/jama.2018.12291)

What: A second study evaluated naloxone accessibility from chain pharmacies in Texas under a standing order from prescribers almost three years after Texas enacted legislation. Under a standing order, prescribers may authorize pharmacists to dispense naloxone without a prescription. In this study, interviewers posed as customers and spoke to pharmacists about wanting to purchase naloxone to have on hand in the event they had to respond to an opioid overdose. Among about 2,300 pharmacies, 84 percent indicated they would dispense the naloxone and 69 percent of pharmacies had the medication in stock. The study was limited by interviewing only one pharmacist per pharmacy and including only Texas chain pharmacies.

Authors: Kirk E. Evoy, Pharm.D., BCACP, BC-ADM, CTTS, the University of Texas at Austin, and coauthors

(doi:10.1001/jama.2018.15892)

Related Material: The editorial, “Overcoming Inertia to Improve Medication Use and Deprescribing,” by Michael A. Steinman, M.D., University of California San Francisco, California, and C. Seth Landefeld, M.D., University of Alabama at Birmingham, is 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 articles 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.

New Physical Activity Guidelines for Americans Released

Posted November 8, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 8 A.M. (ET), MONDAY, NOVEMBER 12, 2018

Media advisory: To contact co-author Katrina L. Piercy, Ph.D., R.D., email Frances Bevington at Frances.Bevington@hhs.gov. The article 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.2018.14854

Bottom Line: Updated physical activity guidelines released by the U.S. Department of Health and Human Services (HHS) tell Americans to get moving, and for how long, with aerobic and muscle-strengthening activities.

Background: Most adults and adolescents in the United States aren’t active enough, although being physically active is one of the most important things people can do to improve their health and reduce their risk for many chronic diseases and conditions.

Who and When: These updated Physical Activity Guidelines for Americans are based on a review of the current science on physical activity and health.

Key Recommendations:

Conclusions: Health professionals and policymakers should promote awareness of the updated guidelines and support efforts to implement programs, practices and policies to facilitate increased physical activity to improve the health of the U.S. population.

Authors: Katrina L. Piercy, Ph.D., R.D., U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion, Rockville, Maryland, and coauthors

Related Material

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

— A summary video is available to view on this page and to embed on your website by copying and pasting the HTML code below. To download the video, email mediarelations@jamanetwork.org for information.

— The JAMA editorial, “New Physical Activity Guidelines – A Call to Activity for Clinicians and Patients,” by Paul D. Thompson, M.D., Hartford Hospital, Hartford, Connecticut, and Thijs M. H. Eijsvogels, Ph.D., Radboud University Medical Center, Nijmegen, the Netherlands.

— The JAMA Viewpoint, “Physical Activity Guidelines for Health and Prosperity in the United States,” by Brett P. Giroir, M.D., and Don Wright, M.D., M.P.H., U.S. Department of Health and Human Services.

Editor’s Note: These guidelines will be presented at the American Heart Association Scientific Sessions 2018 on Monday, November 12.

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.

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=5853923900001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

Trends in Opioid Prescriptions in Children, Adolescents

Posted November 8, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 12, 2018

Media advisory: To contact author Brian T. Bateman, M.D., M.Sc., email Elaine St. Peter at estpeter@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/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.3668

Bottom Line: Prescription opioids dispensed to children and adolescents have steadily decreased since 2012 in an analysis of data from a large commercial insurance provider. The analysis include all oral opioids used for pain, excluding cough suppressants, and individuals with a health care claim associated with a cancer diagnosis were excluded. In 2004, an average of 3 of every 1,00 children and adolescents received an outpatient opioid prescription in a given month and that increased to 4 per 1,000 between 2009 to 2012 before dropping to 2 of every 1,000 children and adolescents in a given month at the start of 2017. The trend in long-term opioid prescription use (three or more consecutive months) also similarly declined. Data for this analysis came only from a single large commercial insurance provider, and opioid dispensing rates may differ in other populations and settings.

Authors: Brian T. Bateman, M.D., M.Sc., Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, and coauthors

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

(doi:10.1001/jamapediatrics.2018.3668)

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.

Combining Hospital, Police Data to Better Understand Violence

Posted November 8, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 12, 2018

Media advisory: To contact corresponding author Steven A. Sumner, M.D., M.Sc., email Courtney Lenard at zvq5@cdc.gov. The full studies are available on the For The Media website.

Want to embed a link to these studies in your story? Links will be live at the embargo time: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.5139

Bottom Line: This research letter suggests that combining hospital and police data might provide a more complete picture of violence in a community because some hospital-treated injuries result from violent incidents unreported to police. Nurses at an emergency department in Atlanta collected information on violent injuries that happened in public places as part of a surveillance system set up for a violence prevention program. The incidents were mapped and researchers sought to assess the percentage of violent injuries treated in the emergency department from incidents unknown to law enforcement. Emergency department screening identified 1,654 violent injuries with 1,122 of them happening in public and a large percentage unreported to police. Limitations of the study include that its findings come from only one city and its focus was on only violence in public places.

Authors: Steven A. Sumner, M.D., M.Sc., 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/jamainternmed.2018.5139)

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.

Exercise Intervention Benefits Older Hospitalized Patients

Posted November 8, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 12, 2018

Media advisory: To contact corresponding author Mikel Izquierdo, Ph.D., email mikel.izquierdo@gmail.com. The full studies are available on the For The Media website.

Want to embed a link to these studies in your story? Links will be live at the embargo time: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4869

Bottom Line: A randomized clinical trial in Spain that included 370 hospitalized patients 75 or older showed an exercise intervention was effective at helping to reverse the functional decline associated with hospitalization for older patients. The exercise intervention, which included two daily sessions of moderate-intensity resistance, balance and walking exercises, was compared with usual care in the hospital, which included physical rehabilitation when it was needed. The exercise intervention group showed improvement on functional capacity scales at hospital discharge, as well as benefits from at the intervention on other endpoints indicative of cognitive status. Limitations of the study include not collecting functional and cognitive data before the acute illness that landed patients in the hospital.

Authors: Mikel Izquierdo, Ph.D, of the Public University of Navarra, Spain, and coauthors

Related Material: The invited commentary, “A Novel Exercise Intervention and Functional Status in Very Elderly Patients During Acute Hospitalization,” by William J. Hall, M.D., M.A.C.P., of the University of Rochester School of Medicine & Dentistry, Rochester, New York., also is available on the For The Media website.

To Learn More: The full study is available on the For The Media 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=5837195432001" allowfullscreen webkitallowfullscreen mozallowfullscreen style="width: 100%; height: 100%; position: absolute; top: 0px; bottom: 0px; right: 0px; left: 0px;"></iframe></div></div>

(doi:10.1001/jamainternmed.2018.4869)

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.

Visual Abstract: Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest

Posted November 6, 2018 by Jim Michalski

A Visual Abstract is available below for the JAMA Network Open study, “Temporal Trends in the Use of Therapeutic Hypothermia for Out-of-Hospital Cardiac Arrest,” by Steven M. Bradley, M.D., M.P.H., Minneapolis Heart Institute, Minneapolis, and coauthors.

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

USPSTF Recommendation Statement on Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults

Posted November 8, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 13, 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.2018.16789

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) recommends screening adults 18 and older, including pregnant women, for unhealthy alcohol use in primary care settings. Those patients who engage in risky or hazardous drinking should be offered brief behavioral counseling interventions to reduce unhealthy alcohol use. The USPSTF also concludes the evidence is insufficient regarding screening for alcohol use in adolescents 12 to 17 in primary care settings.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement is an update of its 2013 recommendation on screening for unhealthy alcohol use in primary care settings. Excessive alcohol use is one of the most common causes of premature death in the United States, with an estimated 88,000 deaths attributed to alcohol occurring annually in the United States from 2006 to 2010. Alcohol use during pregnancy is also one of the major preventable causes of birth defects and developmental disabilities.

The USPSTF Concludes:

Related Material

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

— An interview with Susan J. Curry, Ph.D., co-author of the recommendation statement.

— Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults – U.S. Preventive Services Task Force Recommendation Statement

— Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults – Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

— JAMA editorial: Screening for Unhealthy Alcohol Use

— JAMA Internal Medicine editorial: Unhealthy Alcohol Use in Primary Care – The Elephant in the Examination Room

— JAMA Psychiatry editorial: Screening and Brief Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adults 18 Years and Older, Including Pregnant Women

— JAMA Pediatrics editorial: Alcohol Use Screening and Behavioral Counseling With Adolescents in Primary Care

— JAMA Patient Page: Screening and Counseling to Reduce Unhealthy Alcohol Use

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

(doi:10.1001/jama.2018.16789)

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.

Adults Report Distress Associated With Difficulty Controlling Sexual Feelings, Behavior

Posted November 6, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 9, 2018

Media advisory: To contact corresponding study author Janna A. Dickenson, Ph.D., email at 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?: Links will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.4468

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: About 10 percent of men and 7 percent of women reported significant levels of distress and social impairment associated with difficulty controlling their sexual feelings, urges and behaviors.

Why The Research Is Interesting: Compulsive sexual behavior disorder (CSBD) is a persistent pattern of failure in controlling intense sexual urges that can result in distress and social impairment. Assessing how common such distress and social impairment are can help to provide the closest estimate of CSBD in the population considering a lack of previous studies and debate around specific symptom presentation and definitions with regard to hypersexuality.

Who and When: 2,325 adults between 18 and 50 who participated in the National Survey of Sexual Health and Behavior and who were randomly sampled nationwide in November 2016

What (Study Measures and Outcomes): Distress and impairment associated with difficulty controlling sexual feelings, urges and behaviors as measured by a screening tool

How (Study Design): This was a survey study.

Authors: Janna A. Dickenson, Ph.D., University of Minnesota, Minneapolis, and coauthors

Results: Of the 2,325 adults, 201 (8.6 percent overall or 10.3 percent of men and 7 percent of women) met the criteria for clinically relevant levels of distress, impairment or both associated with difficulty controlling their sexual feelings, urges and behaviors.

Study Limitations: The behavior screening tool may not always be accurate and the survey didn’t assess additional causes of distress about participants’ sexual behavior.

Study Conclusions:

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

(doi:10.1001/jamanetworkopen.2018.4468)

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.

Untreated Hearing Loss Associated with Increased Risk of Hospitalization, Other Health Conditions

Posted November 6, 2018 by Jim Michalski

JAMA Otolaryngology-Head & Neck Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, NOVEMBER 8, 2018

Media advisory: To contact corresponding author Nicholas S. Reed, Au.D., email Raigan Wheeler at rwheel13@jhmi.edu. To contact corresponding author Jennifer A. Deal, Ph.D., email Barbara Benham at bbenham1@jhu.edu. The full studies are available on the For The Media website.

Want to embed a link to these studies in your story? Links will be live at the embargo time

Reed study: http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2018.2875

Deal study: http://jamanetwork.com/journals/jamaotolaryngology/fullarticle/10.1001/jamaoto.2018.2876

Bottom Line: Two studies and two commentaries examine the association of untreated hearing loss with health care use, costs and other health conditions.

What: More than 38 million adults in the United States experience hearing loss; however, fewer than 20 percent report using hearing aids. In one study, researchers examined health care use and costs over 10 years among about 4,700 adults 50 and older with and without untreated hearing loss who were included in a health insurance database. Researchers report untreated hearing loss was associated with more hospitalizations, increased risk of 30-day hospital readmission, increased risk of emergency department visits and longer hospital stays. Over a 10-year period, people with untreated hearing loss incurred an average of $22,000 more in health care costs than people without hearing loss. Limitations of the study are inherent to using claims data, including data coding processes designed for billing not research.

Authors: Nicholas S. Reed, Au.D., Johns Hopkins School of Medicine. Baltimore, and coauthors

(doi:10.1001/jamaoto.2018.2875)

What: Another data analysis of the same group of adults examined the association between a diagnosis of hearing loss and other health conditions. Researchers report hearing loss was associated with an increased 10-year risk of a range of health conditions, including dementia, depression, falls and heart attack. More studies are needed to understand the reasons underlying these associations and whether treatment for hearing loss might reduce risk for these conditions.

Authors: Jennifer A. Deal, Ph.D., Johns Hopkins Bloomberg School of Public Health, Baltimore, and coauthors

(doi:10.1001/jamaoto.2018.2876)

Related Material Also available on the For The Media website:

— An interview with Nicholas S. Reed, Au.D, co-author of “Trends in Health Care Costs and Utilization Associated With Untreated Hearing Loss Over 10 Years.”

— The commentaries, “The Invisible Costs of Hearing Loss,” by Michael M. McKee, M.D., M.P.H., University of Michigan Medical School, Ann Arbor, and “Association of Age-Related Hearing Loss With Multiple Adverse Health Outcomes,” by David Loughrey, Ph.D., University of California San Francisco, and Trinity College Dublin, Ireland.

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

Editor’s Note: Please see the articles 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.

Quantity of Opioids Prescribed After Surgery Associated With Higher Patient Use

Posted November 5, 2018 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, NOVEMBER 7, 2018

Media advisory: To contact corresponding author Joceline Vu, 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.2018.4234

Bottom Line: Changing how opioids are prescribed after surgery requires understanding the factors associated with patients’ use of the pain-relieving medications. This study describes opioid prescribing and use after surgery among almost 2,400 patients in Michigan who underwent 1 of 12 surgical procedures in 2017. Overall, more opioids were prescribed than used, with patients using about 27 percent of the opioids prescribed. The size of an opioid prescription was associated with opioid use, with patients using an additional five pills for every 10 extra pills prescribed. The study is limited by data that relied on patients’ recollections of how many pills they used, which may not be accurate.

Authors: Joceline Vu, M.D., University of Michigan, Ann Arbor, and coauthors

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

(doi:10.1001/jamasurg.2018.4234)

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.

Having High Blood Pressure as Young Adult Associated With Increased Risk of Later Cardiovascular Disease Events

Posted November 1, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 6, 2018

Media advisory: To contact corresponding author Yuichiro Yano, M.D., Ph.D., email Sarah Avery at sarah.avery@duke.edu. To contact corresponding author Sang Min Park, M.D., Ph.D., M.P.H., email smpark.snuh@gmail.com. The full studies are available on the For The Media website.

Want to embed a link to these studies in your story? Links will be live at the embargo time

Yano study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.13551

Park study: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.16501

Bottom Line: Two studies and two editorials examine the relationship between having high blood pressure as an adult younger than 40 and increased risk of later cardiovascular disease events.

What: In one study, about 4,800 African American and white adults had blood pressure measurements taken before age 40. Adults with elevated blood pressure (systolic blood pressure [SBP] of 120 to 129 mm Hg; diastolic blood pressure [DBP] less than 80 mm Hg), stage 1 hypertension (SBP of 130 to 139 mm Hg; DBP of 80 to 89 mm Hg) or stage 2 hypertension (SBP of 140 mm Hg or greater; DBP of 90 mm Hg or greater) before age 40 had an associated higher risk for cardiovascular disease (CVD) events such as fatal and nonfatal coronary heart disease, heart failure or stroke compared with adults who had normal blood pressure during a follow-up of about 19 years. The blood pressure classification in the new guidelines from the American College of Cardiology/American Heart Association may help identify young adults at higher risk for cardiovascular disease events.

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

(doi:10.1001/jama.2018.13551)

What: A second study included data from the Korean National Health Insurance Service for about 2.5 million adults between the ages of 20 and 39 who had a blood pressure measurements taken over four years and who were followed up over another 10 years for CVD (defined as two or more days of hospitalization due to CVD or death due to CVD). Researchers report that adults with stage 1 or 2 hypertension before age 40 had an increased risk of subsequent CVD compared with adults with normal blood pressure. The study population was from a single country so the results may not be generalizable to others.

Authors: Sang Min Park, M.D., Ph.D., M.P.H., Seoul National University, Seoul, South Korea, and coauthors

(doi:10.1001/jama.2018.16501)

Related Material: The editorials, “High Blood Pressure in Young Adulthood and Risk of Premature Cardiovascular Disease,” by Ramachandran S. Vasan, M.D., Boston University School of Medicine, Boston, and “Hypertension—A Public Health Challenge of Global Proportions,” by Naomi D. L. Fisher, M.D., Brigham and Women’s Hospital, Boston, and Gregory Curfman, M.D., Deputy Editor, JAMA, also are 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 articles 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.

Podcast – Battle of the Heart Societies: Who Is Right – the U.S. or Europe Regarding How to Manage Hypertension?

Posted November 1, 2018 by Jim Michalski

Within the last 2 years, major guidelines have been issued from U.S.-based and European organizations that differ in their recommendations for the diagnosis and treatment of hypertension. In this podcast, experts from both sides of the Atlantic—Paul Whelton, M.D., from the United States (Tulane University, New Orleans, Louisiana) and Bryan Williams, M.D., from Europe (University College London in England)—discuss the similarities and differences in these guidelines and the basis for the differences. They were interviewed by JAMA editors Greg Curfman, M.D., and Ed Livingston, M.D.

Does Use of an Inhaler with Inorganic Nitrite Improve Exercise Capacity for Patients with a Common Type of Heart Failure?

Posted November 1, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, NOVEMBER 6, 2018

Media advisory: To contact corresponding author Barry A. Borlaug, M.D., email Traci Klein 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.2018.14852

Bottom Line: About half of patients with heart failure have a form of the condition with normal pump function that is called heart failure with preserved ejection fraction. This form of heart failure is characterized by symptoms such as fatigue, shortness of breath and difficulty being physically active. This randomized clinical trial of 105 patients with this kind of heart failure examined the effects on exercise capacity after four weeks of inhaled, nebulized inorganic nitrite compared with placebo. Researchers report the treatment wasn’t effective compared with placebo for improving exercise capacity in patients.

Authors: Barry A. Borlaug, M.D., Mayo Clinic and Foundation, Rochester, Minnesota, and coauthors

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

Related Material: The editorial, “Hypertension—A Public Health Challenge of Global Proportions,” by Naomi D. L. Fisher, M.D., Brigham and Women’s Hospital, Boston, and Gregory Curfman, M.D., Deputy Editor, JAMA, 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/jama.2018.14852)

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.

Was General Anesthesia for Surgery Associated With Risk of Adverse Child Development in Study of Siblings?

Posted November 1, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, NOVEMBER 5, 2018

Media advisory: To contact author James D. O’Leary, M.D., email Jessamine Luck at jessamine.luck@sickkids.ca. 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.2018.3662

Bottom Line: Surgery under general anesthesia for young children before they started elementary school wasn’t associated with increased risk of adverse child development outcomes compared with their biological siblings who didn’t have surgery and after accounting for other potential biological and environmental factors. The study of children in Ontario, Canada, included 2,346 sibling pairs where only one sibling had surgery. Child development outcomes were based on a measure used to assess children’s readiness to learn in five areas (physical health and well-being, social knowledge and competence, emotional health and maturity, language and cognitive development, and communication skills and general knowledge). Most children in the study group had a single uncomplicated surgical procedure so the study findings may not be generalizable to children who had lengthy or repeat procedures.

Authors: James D. O’Leary, M.D., of the Hospital for Sick Children (SickKids), Toronto, Canada, and coauthors

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

(doi:10.1001/jamapediatrics.2018.3662)

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.

Halloween Associated with Increased Risk of Pedestrian Fatalities

Posted October 26, 2018 by Jim Michalski

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, OCTOBER 30, 2018

Media advisory: To contact author John A. Staples, M.D., M.P.H., email john.a.staples@gmail.com and to contact author Donald Redelmeier email dar@ices.on.ca. 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.2018.4052

Bottom Line: Children in the United States celebrate Halloween by going door-to-door collecting candy. New research suggests the popular October 31 holiday is associated with increased pedestrian traffic fatalities, especially among children. Researchers used data from the National Highway Traffic Safety Administration to compare the number of pedestrian fatalities from 1975 to 2016 that happened on October 31 each year between 5 p.m. and 11:59 p.m. with those that happened during the same hours on a day one week earlier (on October 24) and a day one week later (on November 7). During the 42-year study period, 608 pedestrian fatalities happened on the 42 Halloween evenings, whereas 851 pedestrian fatalities happened on the 84 other evenings used for comparison. The relative risk (an expression of probability) of a pedestrian fatality was higher on Halloween than those other nights. Absolute mortality rates averaged 2.07 and 1.45 pedestrian fatalities per hour on Halloween nights and the other evenings, respectively, which is equivalent to the average Halloween resulting in four additional pedestrian deaths each year. The biggest risk was among children ages 4 to 8. Absolute risk of pedestrian fatality per 100 million Americans was small and declined from 4.9 to 2.5 between the first and final decades of the study interval. Ways to prevent Halloween pedestrian fatalities could include slowing down traffic and automated speed enforcement in residential neighborhoods, as well as improving pedestrian visibility by limiting on-street parking and putting reflective patches on children’s clothing.

Authors: John A. Staples, M.D., M.P.H., University of British Columbia, Vancouver, Canada, and coauthors

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

(doi:10.1001/jamapediatrics.2018.4052)

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.

Study Examines Racial Disparities in Patient Characteristics, Survival After Heart Attack

Posted October 30, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 2, 2018

Media advisory: To contact corresponding study author Garth Graham, M.D., M.P.H., email newsmedia@saint-lukes.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.2018.4240

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: This study analyzed data for about 6,400 patients who had heart attacks to compare black and white patients across a range of characteristics (demographic, socioeconomic status, social factors, lifestyle factors, medical history, clinical presentation, health status and depression). Researchers looked at how these patient characteristics differed by race, how they were associated with survival after heart attack, and whether the association differed for black and white patients who had similar characteristics. Analyses suggest a difference in mortality rate based on characteristics that were more common in black patients but no differences in survival rates at one and five years between black and white patients with similar characteristics. These findings call for more understanding about how and why certain patient characteristics that are more common in black patients, such as lower socioeconomic status, are associated with survival so that new strategies can be developed to reduce observed racial disparities.

Authors: Garth Graham, M.D., M.P.H., Saint Luke’s Mid America Heart Institute, Kansas City, Missouri, and co-authors

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

(doi:10.1001/jamanetworkopen.2018.4240)

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.

How Often Are Cost Considerations Documented in Clinical Notes?

Posted October 30, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, NOVEMBER 2, 2018

Media advisory: To contact corresponding study author Deborah D. Gordon, M.B.A., email Gail Chalef at gail_chalef@hks.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/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.4178

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: Treatment in intensive care units (ICUs) is driven by urgency rather than economic considerations. Many clinicians have been trained not to consider financial issues when making treatment decisions but health care costs can be an important concern for patients and their families. To investigate how financial concerns are associated with health care decision making, researchers analyzed clinical notes from more than 46,000 ICU admissions at a large academic medical center. They report nearly 2,000 patients (about 4 percent) had at least one note reflecting financial considerations during the ICU stay. Among the total admissions, 142 (0.3 percent) included notes describing a change in the discharge plan, 142 (0.3 percent) describing a change in the treatment plan, and 303 (0.7 percent) describing a change in medication or previous nonadherence to medication associated with financial considerations. The findings highlight the importance of understanding how financial constraints may alter treatment decisions in ICUs.

Authors: Deborah D. Gordon, M.B.A., Harvard Kennedy School, Cambridge, Massachusetts, and coauthors

Visual Abstract

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

(doi:10.1001/jamanetworkopen.2018.4178)

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.

Studies Focus on Financial Conflicts of Interest Disclosures by Authors of Clinical Practice Guidelines

Posted October 25, 2018 by Jim Michalski

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, OCTOBER 29, 2018

Media advisory: To contact corresponding author Samir C. Grover, M.D., M.Ed., F.R.C.P.C., email Heidi Singer at Heidi.Singer@utoronto.ca. To contact corresponding author Tyler R. Combs, B.S., email Melani Hamilton at melani.hamilton@okstate.edu. The full studies are available on the For The Media website.

Want to embed a link to these studies in your story? Links will be live at the embargo time. Grover study: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.5106

Combs study: http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2018.4730

Bottom Line: Two studies and an Editor’s Note focus on financial conflicts of interest disclosures by authors of clinical practice guidelines (CPGs).

What: One study reports that authors of CPGs related to high-revenue medications have a substantial number of undeclared payments from industry, including from pharmaceutical companies that market the medications recommended in those CPGs. Researchers identified 18 CPGs that provided recommendations for the top 10 revenue medications of 2016, written by 160 authors who were U.S.-based physicians. Nearly half of the authors declared a payment in the CPG or supplemental materials. More than half (57 percent) of the authors had a financial conflict of interest and about a quarter had received but not disclosed payments from companies marketing one of the medications recommended in the CPGs. In addition, most guidelines failed to adhere to national standards for financial conflicts of interest in CPGs. A limitation of the study is the potential inaccuracies in the reported data.

Authors: Samir C. Grover, M.D., M.Ed., F.R.C.P.C., University of Toronto, and coauthors

(doi:10.1001/jamainternmed.2018.5106)

What: The second study reports that financial conflicts of interest disclosures of authors of gastroenterology CPGs often don’t agree with what’s reported in a payments database. Researchers evaluated industry payments received by 83 authors of 15 gastroenterology CPGs and their financial conflicts of interest disclosure practices. More than half (53 percent) of the authors received industry payments; the median total payments received by guideline authors was $1,000. Financial conflicts of interest disclosures of authors of these CPGs agreed with the Centers for Medicare and Medicaid Services OpenPayments database between 19 percent and 34 percent of the time. A limitation of the study was the ability to only evaluate a period of 12 months for each guideline.

Authors: Tyler R. Combs, B.S., Oklahoma State University, Tulsa, and coauthors

(doi:10.1001/jamainternmed.2018.4730)

Related material: The Editor’s Note, “Continuing Problems With Financial Conflicts of Interest and Clinical Practice Guidelines,” 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 articles 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.

Prenatal Exposures to Medication Affecting Brain Neurotransmitter Systems and Risk of ASD

Posted October 29, 2018 by Deanna Bellandi

JAMA Psychiatry

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, OCTOBER 31, 2018

Media Advisory: To contact corresponding author Magdalena Janecka, Ph.D., email Elizabeth Dowling at Elizabeth.Dowling@mountsinai.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.2018.2728

Bottom Line: An exploratory study that examined autism spectrum disorder (ASD) risk and prenatal exposure to medications that affect neurotransmitters, including the typical targets of antidepressants and antipsychotics, suggests that most medications weren’t associated with higher estimates of ASD risk. The study used data from a large health maintenance organization in Israel for an analytic sample that included 34 groups of medications and 96,249 children, including 1,405 with ASD. Children exposed prenatally to the medications were compared with those not exposed. Most associations between ASD risk and prenatal exposure to the medications were modified when maternal diagnoses were considered. The authors acknowledge their findings needs to be replicated in other studies and that they may not be generalizable because rates of ASD in Israel are low.

Authors: Magdalena Janecka, Ph.D., of the Icahn School of Medicine at Mount Sinai, New York, New York, and coauthors

Related Material: An author podcast and the editorial, “A Biology-First Approach in Perinatal Pharmacoepidemiology of Autism: Potential and Pitfalls,” by Diana Schendel, Ph.D., Aarhus University, Denmark, 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/ jamapsychiatry.2018.2728)

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.

Do High-Performing Schools Lead to Less Risky Teen Marijuana Use?

Posted October 25, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, OCTOBER 29, 2018

Media advisory: To contact corresponding author Rebecca N. Dudovitz, M.D., M.S., email Elaine Schmidt at ESchmidt@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/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.3074

Bottom Line: Results of admissions lotteries at five high-performing public charter schools in low-income minority communities in Los Angeles, California, were used to examine the relationship between exposure to high-performing schools and risky teen behaviors. The admissions lotteries served as a natural experiment in this study of 1,270 students who applied to at least 1 of the 5 high schools. The study’s primary outcome was self-reported marijuana use but it also looked at other health outcomes and factors. Winning the admissions lottery was associated with less marijuana misuse. The authors call school environments an important prevention tool that should be targeted in addressing social determinants of health.

Authors: Rebecca N. Dudovitz, M.D., M.S., of the David Geffen School of Medicine at UCLA, Los Angeles, California, and coauthors

Related Material: The editorial, “Addressing Risky Health Behaviors Among Vulnerable Youth Through the School Environment: Location, Location, Location,” by Kendra S. Liljenquist, Ph.D., of the University of Washington, and Yumaini R. Corker, M.D., M.B.A., of Seattle Children’s Research Institute, both in Seattle, Washington, 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.2018.3074)

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.

Author Interview: Evaluation of Wound Photography for Remote Postoperative Assessment

Posted October 22, 2018 by Jim Michalski

Listen to an interview with Benjamin K. Poulose, M.D., M.P.H., Vanderbilt University Medical Center, Nashville, Tennessee, co-author of the JAMA Surgery study, “Evaluation of Wound Photography for Remote Postoperative Assessment of Surgical Site Infections.” The podcast is available for listening and download on this page.

Factors Associated With Persistent Opioid Use Among Injured Workers

Posted October 23, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, OCTOBER 26, 2018

Media advisory: To contact corresponding study author Gerard P. Slobogean, M.D., M.P.H., F.R.C.S.C., email Karen Warmkessel at kwarmkessel@umm.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.2018.4050

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: Persistent opioid use was common among injured workers who filed workers’ compensation claims. This observational study included more than 9,500 injured workers who filed claims in Maryland from 2008 to 2016 and who were initially treated with an opioid prescription. Nearly 30 percent of those injured workers continued to fill opioid prescriptions more than 90 days after injury. Factors including older age, a preinjury income of more than $60,000, crush injuries, strain or sprain injuries, claims resulting in permanent total disability, and an associated diagnosis of chronic joint pain were associated with persistent opioid use. The study’s authors suggest evaluating the effectiveness of alternative pain management strategies and interventions to lower persistent opioid use that target patients with characteristics identified in the study.

Authors: Gerard P. Slobogean, M.D., M.P.H., F.R.C.S.C., University of Maryland School of Medicine, Baltimore, and coauthors

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

(doi:10.1001/jamanetworkopen.2018.4050)

Editor’s Note: The article contains funding/support and 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.

Study Examines Subsequent Flu Vaccine Effectiveness in Children Previously Vaccinated

Posted October 23, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, OCTOBER 26, 2018

Media advisory: To contact corresponding study author Huong Q. McLean, Ph.D., M.P.H., email Jeff Starck at starck.jeffrey@marshfieldclinic.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.2018.3742

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: Influenza vaccination one year wasn’t associated with reduced vaccine effectiveness the next year in children, findings the authors of this study say support current recommendations for children to be vaccinated annually against influenza. The effects of prior-season influenza vaccination on subsequent vaccine effectiveness aren’t well understood in children. This study analyzed data from a vaccine effectiveness study conducted over three seasons that examined the association of prior-season vaccination with vaccine effectiveness and the risk of influenza among vaccinated children between the ages of 2 and 17 by the vaccine type they received. While influenza vaccine effectiveness varied by influenza type and subtype and vaccine type, prior-season vaccination wasn’t associated with reduced vaccine effectiveness.

Authors: Huong Q. McLean, Ph.D., M.P.H., Marshfield Clinic Research Institute, Marshfield, Wisconsin, and co-authors

Related Material: The invited commentary, “Repeated Vaccination May Protect Children From Influenza Infection,” by Sarah Cobey, Ph.D., University of Chicago, also is available on the For The Media website.

Visual Abstract:

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

(doi:10.1001/jamanetworkopen.2018.3742)

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.

Clinical, Financial Burden Associated With Firearm-Related Injuries in Pediatric Patients

Posted October 25, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, OCTOBER 29, 2018

Media advisory: To contact corresponding author Faiz Ganim M.B.B.S., email Beatriz Vianna at bvianna@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/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.3091

Bottom Line: This research letter describes trends in the clinical and financial burden associated with firearm-related injuries among pediatric patients. About 75,000 emergency department (ED) visits were identified for patients younger than 18 for firearm-related injuries from 2006 through 2014, and total charges for the ED visit or an inpatient admission were pulled from each record. ED visits for firearm-related injuries decreased until 2013 and then increased from 2013 through 2014; ED visits were more common for male patients, especially those between the ages of 15 to 17; and assault was the most common intent of the injury, followed by unintentional injuries and suicides. Total charges associated with the injuries were about $2.5 billion. The study has some limitations due to the Nationwide Emergency Department Sample that was used and researchers weren’t able to follow-up on patients after discharge.

Authors: Faiz Gani, M.B.B.S., and Joseph K. Canner, M.H.S., of the Johns Hopkins University School of Medicine, Baltimore, Maryland

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

(doi:10.1001/jamapediatrics.2018.3091)

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.

Audio Interview: Association of Organic Food Consumption With Cancer Risk

Posted October 18, 2018 by Deanna Bellandi

Some Weather Conditions Associated With Heart Attack Risk

Posted October 22, 2018 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, OCTOBER 24, 2018

Media advisory: To contact corresponding author David Erlinge, M.D., Ph.D., email david.erlinge@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/jamacardiology/fullarticle/10.1001/jamacardio.2018.3466

Bottom Line: Some weather conditions are associated with risk of heart attack. This observational study examined data for more than 274,000 patients who had heart attacks reported in Sweden from 1998 to 2013 and for which weather data were available over the same period of time. Days with low air temperature, low atmospheric air pressure, high wind velocity and shorter periods of sunshine were associated with risk of heart attack. The strongest association appeared to be for air temperature, with a higher risk of heart attack on days when air temperatures were less than 32°F. Although results observed in the study were statistically significant, the differences were modest.

Authors: David Erlinge, M.D., Ph.D., Lund University, Lund, Sweden, and coauthors

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

(doi:10.1001/jamacardio.2018.3466)

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

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

Visual Abstract: Insurance Coverage Denials for ED Visits With Nonemergent Diagnoses

Posted October 16, 2018 by Jim Michalski

A Visual Abstract is available below for the JAMA Network Open study, “Analysis of a Commercial Insurance Policy to Deny Coverage for Emergency Department Visits With Nonemergent Diagnoses,” by Shih-Chuan Chou, M.D., M.P.H., Brigham and Women’s Hospital, Boston, and coauthors.

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

Medical Crowdfunding for Treatments Unsupported by Evidence or Potentially Unsafe

Posted October 18, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, OCTOBER 23, 2018

Media advisory: To contact corresponding author Ford Vox, M.D., email Kerry Ludlam at kerry.ludlam@shepherd.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.2018.10264

Bottom Line: Medical crowdfunding is using social media to appeal for help in paying for medical care. These campaigns can fill insurance gaps but they can also raise money for scientifically unsupported, ineffective or potentially dangerous treatments. This study examined crowdfunding activity for five such treatments since November 2015 and identified more than 1,000 campaigns that raised nearly $6.8 million. The campaigns collected money for homeopathic or naturopathic cancer treatments, hyperbaric oxygen therapy for brain injury, stem cell therapies for brain and spinal cord injury, and long-term antibiotic therapy for chronic Lyme Disease. Limitations of the study include only five treatments and four crowdfunding platforms were analyzed.

Authors: Ford Vox, M.D., Brain Injury Rehabilitation, Shepherd Center, Atlanta, and coauthors

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

(doi:10.1001/jama.2018.10264)

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.

Shift in Types of Weight-Loss Surgery Performed Among Pediatric Patients

Posted October 18, 2018 by Deanna Bellandi

JAMA Pediatrics

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, OCTOBER 22, 2018

Media advisory: To contact corresponding author Numa P. Perez, 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/jamapediatrics/fullarticle/10.1001/jamapediatrics.2018.3030

Bottom Line: This study identified a shift in the kind of metabolic and bariatric surgery (so-called MBS surgery because it can help patients achieve long-term weight loss and the resolution of coexisting metabolic conditions such as type 2 diabetes) performed among pediatric patients. An estimated 14,178 MBS procedures were performed among patients 20 or younger from 2005-2014. This research letter reports an increasing frequency of vertical sleeve gastrectomy and decreasing frequency of laparoscopic Roux-en-Y gastric bypass and the use of the adjustable gastric band, all changes that reflect trends in adult MBS procedures.

Authors: Numa P. Perez, Jr., M.D., of Massachusetts General Hospital, Boston, and coauthors

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

(doi:10.1001/jamapediatrics.2018.3030)

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 Examines Long-Term Rate of Mesh Sling Removal, Reoperation

Posted October 18, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, OCTOBER 23, 2018

Media advisory: To contact corresponding author Ipek Gurol-Urganci, Ph.D., email press@lshtm.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/jama/fullarticle/10.1001/jama.2018.14997

Bottom Line: Treatment for women with stress urinary incontinence (SUI) can include inserting a mesh sling to support the urethra. An estimated 250,000 midurethral mesh sling (MUS) operations were performed in 2010 in the United States. There is concern that some women experience pain, persistent urinary incontinence and other issues but little clinical trial evidence exists about these longer-term outcomes. This observational study examined long-term mesh removal and reoperations in about 95,000 women in England who underwent MUS operations for SUI between 2006 and 2015. Within nine years, the rate of sling removal was 3.3 percent and the rate of reoperation for SUI was 4.5 percent. Reasons for removal or reoperations weren’t available.

Authors: Ipek Gurol-Urganci, Ph.D., London School of Hygiene & Tropical Medicine, London, and coauthors

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

(doi:10.1001/jama.2018.14997)

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.

USPSTF Recommendation Statement on Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults

Posted October 18, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, OCTOBER 23, 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.2018.14741

Bottom Line: The U.S. Preventive Services Task Force (USPSTF) recommends clinicians screen women of reproductive age for intimate partner violence and then connect women who screen positive to ongoing support services. However, current evidence is insufficient regarding screening older or vulnerable adults for abuse and neglect.

Background: The USPSTF routinely makes recommendations about the effectiveness of preventive care services. This latest statement is an update of its 2013 recommendation on screening for intimate partner violence (IPV), elder abuse, and abuse of vulnerable adults, which are common in the United States but often remain undetected. In addition to the immediate effects of intimate partner violence, which may include injury and death, there may be other health consequences, including the development of depression, anxiety, substance abuse, and chronic pain. Long-term negative health effects from elder abuse may include higher risk of nursing home placement and death.

The USPSTF Concludes:

Related Material

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

— Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults – US Preventive Services Task Force Final Recommendation Statement

— Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults – Evidence Report and Systematic Review for the US Preventive Services Task Force

— JAMA editorial: Challenges and Opportunities for Studying Routine Screening for Abuse

— JAMA Internal Medicine editorial: Addressing Intimate Partner Violence and Abuse of Older or Vulnerable Adults in the Health Care Setting – Beyond Screening

— JAMA Patient Page: Screening for Intimate Partner Violence, Elder Abuse, and Abuse of Vulnerable Adults

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

(doi:10.1001/jama.2018.14741)

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.

Pod-Based Electronic Cigarette Use Among California Youth

Posted October 16, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, OCTOBER 19, 2018

Media advisory: To contact corresponding study author Bonnie Halpern-Felsher, Ph.D., email Erin Digtale at digitale@stanford.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.2018.3535

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: Adolescents and young adults who used new pod-based electronic cigarettes commonly did so along with other e-cigarettes and traditional cigarettes.

Why The Research Is Interesting: E-cigarettes are the most commonly used tobacco product among adolescents and young adults. More information is needed on how new pod-based e-cigarette products affect attitudes, initiation and use of tobacco products. This study examined pod-based e-cigarette use and compared it with the use of other e-cigarettes and traditional cigarettes by California adolescents and young adults.

Who and When: 445 California adolescents and young adults (average age 19) from an ongoing study with data collected in 2018 about the use of tobacco products and perceptions of tobacco products

What (Study Measures and Outcomes): Use of pod-based e-cigarettes, e-cigarettes and traditional cigarettes (exposures); use of the products at various intervals, use of flavors and nicotine in pod-based e-cigarettes and e-cigarettes; and perceptions about risks, benefits and nicotine dependence (outcomes)

How (Study Design): This was a survey study.

Authors: Bonnie Halpern-Felsher, Ph.D., Stanford University, Palo Alto, California, and coauthors

Results: Among users of pod-based cigarettes, the use of other e-cigarettes and cigarettes was common (see image below); the first pod ever used was flavored for the majority of users; and the average perceived chances of experiencing social and health risks from either pod-based e-cigarettes or other e-cigarettes was about 40 percent.

Study Limitations: The survey drew only from California schools and survey questions about pod-based e-cigarettes weren’t designed to address differences in understanding of the devices.

Study Conclusions:

Related Material: The invited commentary, “Pod Mod Electronic Cigarettes – An Emerging Threat to Public Health,” by Tory R. Spindle, Ph.D., of Johns Hopkins University School of Medicine, Baltimore, Maryland, and Thomas Eissenberg, Ph.D., of Virginia Commonwealth University, Richmond, 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.2018.3535)

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.

Did Leonardo da Vinci Have a Vision Disorder That May Have Helped Him Capture Space on a Flat Canvas?

Posted October 16, 2018 by Jim Michalski

JAMA Ophthalmology

EMBARGOED FOR RELEASE: 11 A.M. (ET), THURSDAY, OCTOBER 18, 2018

Media advisory: To contact corresponding author Christopher W. Tyler, Ph.D., D.Sc., email cwtyler2020@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/jamaophthalmology/fullarticle/10.1001/jamaophthalmol.2018.3833

Bottom Line: Beginning with Rembrandt, a number of famous artists have been identified as having strabismus, a misalignment of the eyes. Some forms of eye misalignment are thought to be beneficial for artistic work by suppressing the deviating eye, which provides 2-dimensional monocular vision advantageous to painting and drawing. In this study, images considered to be of Leonardo da Vinci (sculptures, oil paintings and drawings) were analyzed. The author found evidence that suggests da Vinci may have had intermittent exotropia (a tendency for the outward turn of an eye). This would result in a capability to switch to monocular vision, which may help to explain his ability to depict the 3-dimensional aspects of faces and objects in the world and the distant depth of mountainous scenes.

Author: Christopher W. Tyler, Ph.D., D.Sc., City University of London, United Kingdom

Images Suggesting Leonardo da Vinci May Have Had Eye Misalignment

Right click on image to download

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

(doi:10.1001/jamaophthalmol.2018.3833)

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

More Caffeine from Coffee Associated With Decreased Rosacea Risk

Posted October 15, 2018 by Deanna Bellandi

JAMA Dermatology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, OCTOBER 17, 2018

Media Advisory: To contact corresponding author Wen-Qiing Li, Ph.D., email Mollie Rappe at mollie_rappe@brown.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.2018.3301

Bottom Line: Consuming caffeine from coffee but not from other foods (tea, soda and chocolate) was associated with less risk of rosacea, a common chronic inflammatory skin disease where the skin appears red and flushed. This observational study included more than 82,000 women in the Nurses’ Health Study II with data collected on coffee, tea, soda and chocolate consumption. Compared with people who had less than one serving of caffeinated coffee per month, those who had four servings or more per day had the lowest risk for rosacea. Decaffeinated coffee wasn’t associated with decreased rosacea risk. Rosacea symptoms may be lessened because of caffeine’s vasoconstrictive and immunosuppressant effects but further studies are to needed to understand the reasons for the observed association.

Authors: Wen-Qing Li, Ph.D., of the Warren Alpert Medical School at Brown University, Providence, Rhode Island, and coauthors

Related Material: The editorial, “One More Reason to Continue Drinking Coffee – It May Be Good for Your Skin,” by Mackenzie R. Wehner, M.D., M.Phil., of the University of Pennsylvania, Philadelphia, and Eleni Linos, M.D., M.P.H., Dr.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/jamadermatol.2018.3301)

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

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

Listen to the Podcast: An Update on the Diagnosis and Treatment of Venous Thromboembolic Disease

Posted October 11, 2018 by Jim Michalski

Listen to an interview with Philip S. Wells, M.D., of the University of Ottawa, Canada, co-author of the JAMA study, “Venous Thromboembolism – Advances in Diagnosis and Treatment.” The podcast is available for listening and download on this page.

Emergency Department Blood Test May Help Rule Out Heart Attack Within 15 Minutes

Posted October 15, 2018 by Jim Michalski

JAMA Cardiology

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, OCTOBER 17, 2018

Media advisory: To contact corresponding author Martin P. Than, M.B.B.S., email martinthan@xtra.co.nz. 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.2018.3368

Bottom Line: A new, quick and accurate, bedside blood test done in an emergency department could help reduce the time it takes to rule out heart attacks. A preliminary study suggests a 15-minute blood test in the emergency department to measure a protein in the blood (cardiac troponin) may have similar ability to rule out a heart attack as blood tests that take longer to be measured in a laboratory. The analysis in this observational study at a single regional emergency department included about 350 patients with symptoms of a heart attack. Confirmation in larger studies is needed.

Authors: Martin P. Than, M.B.B.S., Christchurch Hospital, Christchurch, New Zealand, and coauthors

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

(doi:10.1001/jamacardio.2018.3368)

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.

How Common Are Tobacco, Marijuana Use in Hip-Hop Music Videos?

Posted October 11, 2018 by Deanna Bellandi

JAMA Internal Medicine

EMBARGOED FOR RELEASE: 11 A.M. (ET), MONDAY, OCTOBER 15, 2018

Media advisory: To contact study author Kristin E. Knutzen, M.P.H., email Paige Stein at Paige.Stein@dartmouth.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.2018.4488

Bottom Line: Popular hip-hop music videos frequently feature tobacco and marijuana use, and because of the genre’s broad appeal, this may contribute to growing public health concern about the use of these products in traditional combustible or new electronic forms.

Why The Research Is Interesting: Hip-hop artists model behavior to their fans because of their prominence and the commentary in their songs. Depictions of tobacco and marijuana use in music videos may help to increase the products’ appeal and decrease fans’ perceptions of risks and harms. This study analyzed leading hip-hop music videos over five years (2013-2017) to characterize the extent to which tobacco and marijuana use appeared.

What and When: 796 hip-hop music videos on Billboard magazine’s weekly Hot R&B/Hip Hop Songs list between 2013 and 2017

Study Measures and Outcomes: How common was the appearance or use of combustible tobacco and marijuana products; the appearance of smoke or vapor; the appearance or use of electronic tobacco and marijuana products; tobacco or marijuana brand placement; and the appearance or use of combustible and electronic tobacco and marijuana by the main or featured artist

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

Authors: Kristin E. Knutzen, M.P.H., of the Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, and coauthors

Results:

Study Limitations: More than 30 percent of leading hip-hop songs didn’t have music videos; and demographic and socioeconomic characteristics and residency weren’t known about people who watched hip-hop videos

Conclusions:

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

(doi:10.1001/jamainternmed.2018.4488)

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 emailmediarelations@jamanetwork.org.

No Decrease in X-Rays for Infants With Lower Respiratory Tract Infections

Posted October 11, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, OCTOBER 16, 2018

Media advisory: To contact corresponding author Brett Burstein, M.D.C.M., Ph.D., M.P.H., email Stephanie Tsirgiotis at stephanie.tsirgiotis@muhc.mcgill.ca. 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.2018.9245

Bottom Line: Revised guidelines recommend against routine X-rays for infants with bronchiolitis, a viral lower respiratory tract infection that often lands babies in the hospital. Unnecessary X-rays contribute to health care costs and radiation exposure. Despite the guidelines, an analysis of emergency department visits in the United States suggests no decrease in the rate of X-rays from 2007 to 2015, with nearly half of children under 2 with bronchiolitis still getting imaging. The study lacked clinical data to determine the appropriateness of X-rays.

Authors: Brett Burstein, M.D.C.M., Ph.D., M.P.H., Montreal Children’s Hospital, Montreal, Canada, and coauthors

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

(doi:10.1001/jama.2018.9245)

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.

Is Weight-Loss Surgery Associated With Lower Risk of Macrovascular Events Like Heart Attack, Stroke for Patients with Type 2 Diabetes?

Posted October 11, 2018 by Jim Michalski

JAMA

EMBARGOED FOR RELEASE: 11 A.M. (ET), TUESDAY, OCTOBER 16, 2018

Media advisory: To contact corresponding author David Arterburn, M.D., M.P.H., email Rebecca Hughes (Rebecca.F.Hughes@kp.org) or Heather Platisha (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? Link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2018.14619

Bottom Line: Macrovascular disease events, which include heart attack and stroke, are a leading cause of illness and death for patients with type 2 diabetes. Medical management, including lifestyle changes, may not reduce patient risk but bariatric surgery may help. In this observational study of about 20,000 patients with severe obesity and type 2 diabetes who underwent bariatric surgery or received usual medical care for diabetes, bariatric surgery was associated with a lower risk of macrovascular disease events at five years of follow-up (2.1 percent vs 4.3 percent). The findings require confirmation in randomized clinical trials.

Authors: David Arterburn, M.D., M.P.H., Kaiser Permanente Washington Health Research Institute, Seattle, and coauthors

Related Material

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

— A video abstract is available to view on this page and to embed on your website by copying and pasting the HTML code below. To download the video, email mediarelations@jamanetwork.org for information.

— The JAMA editorial, “Preventing Macrovascular Events With Bariatric Surgery,” by Sayeed lkramuddin, M.D., M.H.A., University of Minnesota, Minneapolis, and coauthors.

— The JAMA Surgery editorial: “Standardized Uniform Reporting and Indications for Bariatric and Metabolic Surgery,” by Paulina Salminen, M.D., Turku University Hospital, Turku, Finland.

— The JAMA study, “Comparison of the Performance of Common Measures of Weight Regain After Bariatric Surgery for Association With Clinical Outcomes,” by Wendy C. King, Ph.D., University of Pittsburgh, and coauthors.

The JAMA editorial, “Setting Appropriate Expectations After Bariatric Surgery,” by Amir A. Ghaferi, M.D., M.S., and Oliver A. Varban, M.D., University of Michigan, Ann Arbor.

Previously published by JAMA: Bariatric Surgery for Type 2 Diabetes

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

(doi:10.1001/jama.2018.14619)

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.

Video embed code:

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Unapproved Ingredients in Over-the-Counter Supplements

Posted October 9, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, OCTOBER 12, 2018

Media advisory: To contact corresponding study author Madhur Kumar, M.S., Ph.D., email Corey Egel at cdphpress@cdph.ca.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/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2018.3337

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: Potentially harmful and undeclared pharmaceuticals were identified in more than 700 over-the-counter dietary supplements in an analysis of U.S. Food and Drug Administration warnings from 2007 through 2016.

Why The Research Is Interesting: More than half of adults in the United States report using dietary supplements, and the FDA has warned about unapproved pharmaceutical ingredients in some of these supplements. This study analyzed data from a tainted supplements database maintained by the FDA for trends in adulterated dietary supplements associated with a warning by the FDA.

What and When: Data from the FDA’s Center for Drug Evaluation and Research, Tainted Products Marketed as Dietary Supplements_CDER database from 2007 through 2016; date, product name, company, hidden ingredients, product category, source of sample and warning type (i.e. voluntary recall, public notification, news release, consumer update or warning letter) for each warning were recorded

How (Study Design): This was a quality improvement study.

Authors: Madhur Kumar, M.S., Ph.D., California Department of Public Health, Sacramento, and coauthors

Results: Unapproved pharmaceutical ingredients were identified in 776 dietary supplements, most of them marketed for sexual enhancement, weight loss or muscle building; 20 percent of the products had more than one unapproved ingredient; and 28 products were named in two or three warnings.

Study Limitations: Analysis was independent of FDA involvement; total number and variety of products tested by the FDA each year are unknown; and findings are limited to drugs for which the FDA tested.

Study Conclusions:

Related Material: The invited commentary, “The FDA and Adulterated Supplements — Dereliction of Duty,” by Pieter A. Cohen, M.D., Somerville Hospital Primary Care, Somerville, Massachusetts, also is available on the For The Media website.

Visual Abstract:

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

(doi:10.1001/jamanetworkopen.2018.3337)

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.

Obesity Associated With Higher Colorectal Cancer Risk Among Younger Women

Posted October 9, 2018 by Deanna Bellandi

JAMA Oncology

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

Media advisory: To contact corresponding author Yin Cao, M.P.H., Sc.D., email Jim Goodwin at jgoodwin@wustl.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.2018.4280

Bottom Line: Obesity was associated with an increased risk of early onset colorectal cancer (CRC) among women younger than 50.

Why The Research Is Interesting: New cases of CRC and death are increasing among people younger than 50 and the reasons for this are largely unknown. This study used data from a large group of women in the Nurses’ Health Study II to examine the association of obesity with CRC diagnosed before age 50.

Who and When: 85,256 women ages 25 to 42 who were free of cancer and inflammatory bowel disease when they enrolled in the study and followed up from 1989 through 2011.

What (Study Measures and Outcomes): Current body mass index (BMI), BMI at age 18 and weight gain since age 18 (exposures); relative risk, which is a statistical measure of probability, for new early onset CRC (outcome)

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: Yin Cao, M.P.H., Sc.D., of the Washington University School of Medicine, St. Louis, Missouri, and coauthors

Results: There were 114 cases of early onset CRC among the 85,256 women studied. Higher current BMI, BMI at age 18 and weight gain since early adulthood were associated with increased risk of early onset CRC. Obesity, which is a BMI of 30 or above, was associated with highest risk.

Limitations: The study included mainly white women so the findings need to be validated among other races/ethnicities and among men.

Study Conclusions: Obesity and weight gain since early adulthood were associated with increased risk of early onset CRC. This study highlights the importance of weight control throughout life and the potential role of body weight in complementing CRC screening for the early detection of early onset CRC.

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

(doi:10.1001/jamaoncol.2018.4280)

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

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

Medical Marijuana for Symptoms in Patients with Multiple Sclerosis

Posted October 9, 2018 by Deanna Bellandi

JAMA Network Open

EMBARGOED FOR RELEASE: 11 A.M. (ET), FRIDAY, OCTOBER 12, 2018

Media advisory: To contact corresponding study author Mari Carmen Torres-Moreno, Ph.D., email mariacarmen.torres@e-campus.uab.cat. 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.2018.3485

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: This study analyzed 17 clinical trials including 3,161 patients to evaluate medicinal cannabinoids — the chemical compounds in cannabis — for the treatment of symptoms in patients with multiple sclerosis (MS). Cannabinoids were associated with a limited and mild reduction in the subjective patient assessment of spasticity (contracted muscles), pain and bladder dysfunction in this 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. The analysis in this report suggests therapy using these drugs can be considered safe, although the number of adverse events is higher than placebo for treating symptoms in patients with MS.

Authors: Mari Carmen Torres-Moreno, Ph.D., Universitat Autònoma de Barcelona (UAB), Spain, and coauthors

Related Material: The invited commentary, “Cannabinoids for Symptoms of Multiple Sclerosis: Benefits to Patients Still Unclear,” by Marissa Slaven, M.D., and Oren Levine, M.D., M.Sc., of McMaster University, Hamilton, 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.2018.3485)

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.

Video: In Memoriam—Honoring the Victims of Opioid Addiction

Posted October 5, 2018 by Deanna Bellandi

The photos below accompany the article and are available for use. Right click to save the image.

Caption: Engraved pills memorializing those who die each year due to prescription opioid misuse.

Caption: Details of the pill engraving.

Long-Term Follow-Up of Using Patients’ Own Fat to Correct Deformities After Breast Cancer Surgery

Posted October 8, 2018 by Jim Michalski

JAMA Surgery

EMBARGOED FOR RELEASE: 11 A.M. (ET), WEDNESDAY, OCTOBER 10, 2018

Media advisory: To contact corresponding author Todor Krastev, M.D., email dr.todor.krastev@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/jamasurgery/fullarticle/10.1001/jamasurg.2018.3744

Bottom Line: One technique to correct disfiguring deformities after breast cancer surgery is autologous fat transfer (AFT or fat grafting), which involves injecting a patient’s own fat into a soft tissue deformity. Previous studies examining the safety of this procedure in regard to cancer relapse have been limited by a relatively short follow-up. This study included nearly 600 women with breast cancer who underwent fat grafting or conventional breast reconstruction. After five years of follow-up, fat grafting wasn’t associated with increased rates of cancer relapse, with no significant difference in the rate of cancer relapse between the two groups. Although the study didn’t demonstrate significant differences in recurrence rates, it cannot eliminate the possibility that an association between AFT and cancer relapse may still be present.

Authors: Todor Krastev, M.D., Ph.D., Maastricht University Medical Centre, Maastricht, the Netherlands, and coauthors

Related material: The commentary, “The Third Postmastectomy Reconstruction Option – Autologous Fat Transfer,” by Roger K. Khouri, M.D., Miami Breast Center. Key Biscayne, Florida 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.2018.3744)

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.