Archive for the ‘JAMA Internal Medicine’ Category

mindfulness-meditation

By Andrew M. Seaman

Mindfulness meditation may be useful in battles against anxiety, depression and pain, according to a fresh look at past research.

Using data from 47 earlier studies, researchers found moderate evidence to support the use of mindfulness meditation to treat those conditions. Meditation didn’t seem to affect mood, sleep or substance use.

“Many people have the idea that meditation means just sitting quietly and doing nothing,” wrote Dr. Madhav Goyal in an email to Reuters Health. “That is not true. It is an active training of the mind to increase awareness, and different meditation programs approach this in different ways.”

Goyal led the study at The Johns Hopkins University in Baltimore.

He and his colleagues write in JAMA Internal Medicine that meditation techniques emphasize mindfulness and concentration.

So-called mindfulness meditation is aimed at allowing the mind to pay attention to whatever thoughts enter it, such as sounds in the environment, without becoming too focused. Mantra meditation, on the other hand, involves focusing concentration on a particular word or sound.

Approximately 9 percent of people in the U.S. reported meditating in 2007, according to the National Institutes of Health. About 1 percent said they use meditation as some sort of treatment or medicine.

For the new report, the researchers searched several electronic databases that catalog medical research for trials that randomly assigned people with a certain condition – such as anxiety, pain or depression – to do meditation or another activity. These randomized controlled trials are considered the gold standard of medical research.

The researchers found 47 studies with over 3,500 participants that met their criteria.

After combining the data, Goyal said his team found between a 5 and 10 percent improvement in anxiety symptoms among people who took part in mindfulness meditation, compared to those who did another activity.

There was also about a 10 to 20 percent improvement in symptoms of depression among those who practiced mindfulness meditation, compared to the other group.

“This is similar to the effects that other studies have found for the use of antidepressants in similar populations,” Goyal said.

Mindfulness meditation was also tied to reduced pain. But Goyal said it’s hard to know what kind of pain may be most affected by meditation.

The benefits of meditation didn’t surpass what is typically associated with other treatments, such as drugs and exercise, for those conditions.

“As with many therapies, we try to get a moderate level of confidence that the therapy works before we prescribe it,” Goyal said. “If we have a high level of confidence, it is much better.”

But he noted that the researchers didn’t find anything more than moderate evidence of benefit from meditation for anxiety, depression and pain.

There was some suggestion that meditation may help improve stress and overall mental health, but the evidence supporting those findings was of low quality.

There was no clear evidence that meditation could influence positive mood, attention, substance use, eating habits, sleep or weight.

“Clinicians should be prepared to talk with their patients about the role that meditation programs could have in addressing psychological stress, particularly when symptoms are mild,” Goyal said.

Dr. Allan Goroll, who wrote an editorial accompanying the new study, told Reuters Health the analysis is an example of an area of much-needed scientific study, because many people make treatment decisions based on beliefs – not data.

“That is particularly the case with alternative and complimentary approaches to treating medical problems,” he said. “It ranges from taking vitamins to undergoing particular procedures for which the scientific evidence is very slim but people’s beliefs are very great.”

Goroll is professor at Harvard Medical School and Massachusetts General Hospital in Boston.

Goyal said people should remember that meditation was not conceived to treat any particular health problem.

“Rather, it is a path we travel on to increase our awareness and gain insight into our lives,” he wrote. “The best reason to meditate is to gain this insight. Improvements in health conditions are really a side benefit, and it’s best to think of them that way.”

SOURCE: bit.ly/WiwDtv JAMA Internal Medicine, online January 6, 2014.

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Many people take aspirin to prevent heart attacks, but new research suggests the added benefits may be coming at the expense of pill-takers’ eyesight.

A 15-year-study published Jan. 22 in JAMA Internal Medicine showed that people taking regular aspirin faced a higher risk for age-related macular degeneration (AMD), one of the leading causes of blindness in older adults. The research also suggests the risk may worsen over time.

AMD commonly affects adults 50 and older, gradually destroying their “macula,” which is a part of the eye that provides sharp, central vision that’s required to see objects clearly. There are two types of the disease: “Dry” AMD is most common and occurs when the light-sensitive cells in the macula slowly break down, gradually blurring central vision while “wet” or neovascular AMD occurs when blood vessels under the macula leak blood and fluid, causing damage. Wet AMD is often more severe but also more rare, affecting about 10 percent of patients with AMD.

People at a high risk for having a heart attack — such as those who have heart disease — are encouraged by the American Heart Association and other medical groups to take a daily low-dose of aspirin.

For the study, Australian researchers tracked nearly 2,400 adults who were given four exams during the 15 year study. More than 250 of these individuals took aspirin regularly because aspirin is thought to prevent clots from forming by “thinning” the blood.

The researchers found an increased risk for wet AMD among aspirin takers, with 1.9 percent of patients having the condition at five years, 7 percent at 10 years and 9.3 percent at 15 years. That compares with 0.8 percent of non-aspirin takers at five years, 1.6 percent at 10 years and 3.7 percent at 15 years.

“Regular aspirin use was significantly associated with an increased incidence of neovascular AMD,” concluded the authors, led by Dr. Gerald Liew of the University of Sydney in Australia.

In December, a study published in JAMA also found that people who used aspirin regularly for 10 years were more likely to have wet AMD, but the overall reported risk was still low.

Liew wrote that the decision to stop taking aspirin is a “complex” one and should be decided on an individual basis. For example, those at a higher risk for AMD such as people with a family history or smokers — who are two times more likely to develop AMD than non-smokers — may want to consider changing their aspirin regimen.

In an accompanying editorial published in the same issue, Dr. Sanjay Kaul and Dr. George A. Diamond, cardiologists at Cedars-Sinai Medical Center, Los Angeles, wrote that the study was observational, and could not prove cause and effect. Therefore, it may be too soon to recommend people curb their aspirin intake.

“In the absence of definitive evidence regarding whether limiting aspirin exposure mitigates AMD risk, one obvious course of action is to maintain the status quo,” they wrote.

Dr. Gregg Fonarow, a spokesman for the American Heart Association and professor of cardiology at the University of California, Los Angeles, added to HealthDay that more rigorous randomized controlled trials have yet to demonstrate any increased risk of blindness from people taking aspirin.

“Individuals prescribed aspirin for high-risk primary prevention or secondary cardiovascular prevention should not be concerned or discontinue this beneficial therapy,” he said.

To reduce your risk for AMD, the National Eye Institute recommends exercising, eating a healthy diet rich in leafy greens and fish, maintaining normal blood pressure and cholesterol, and avoiding smoking.

http://www.cbsnews.com/8301-204_162-57565181/daily-aspirin-may-increase-risk-for-age-related-blindness/