EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 21, 2004
To contact Padraig E. O'Suilleabhain, M.B., B.Ch., call Rachel Horton at 214/648-3404.

PATIENTS WITH PARKINSON DISEASE AND HIGH HOMOCYSTEINE LEVELS MAY BE MORE LIKELY TO BE DEPRESSED

CHICAGO—Patients with Parkinson disease (PD) who also have high levels of homocysteine (an amino acid produced by the body) are more likely to be depressed compared with other patients with PD who have normal levels of homocysteine, according to an article in the June issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to information in the article, elevated homocysteine (Hcy) levels have been associated with an increased risk of dementia and Alzheimer disease. High concentrations of Hcy have been associated with a decrease in cognitive functioning, even in elderly patients without dementia, the article states. PD patients in particular are at risk for elevated levels of Hcy because the metabolism of levodopa, a drug commonly used to treat the disease, produces Hcy.

Padraig E. O'Suilleabhain, M.B., B.Ch., of The University of Texas Southwestern Medical Center at Dallas, and colleagues examined whether high Hcy levels were associated with depression or with cognitive, or physical impairments in patients with PD.

The researchers studied 97 patients with an average duration of PD of 3.6 years. Patients were divided into two groups: those with normal Hcy levels (n=66) and those with elevated Hcy levels (n=31). Participants completed a depression survey and underwent a variety of cognitive and motor tests. Fifty-four participants were taking levodopa.

"An elevated plasma Hcy concentration … was present in 31 (32 percent) of our 97 patients with fairly recent onset PD," the authors write. "An elevated Hcy level is most likely due to the prevalent use of levodopa: as in previous studies, the patients taking levodopa had higher Hcy levels than those not taking levodopa."

The researchers found that patients with elevated Hcy levels were slightly older (68 vs. 62 years), were more depressed, and had worse cognitive functioning, but had no difference in physical functioning measures.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 21, 2004
To contact corresponding author Seth L. Pullman, M.D., F.R.C.P.C., call Annie Bayne at 212/305-3900. To contact editorialist Roger N. Rosenberg, M.D., call Rachel Horton at 214/648-3404.

PROCEDURE APPEARS TO BOOST MOTOR SKILLS IN PATIENTS WITH PARKINSON DISEASE

CHICAGO—Patients with Parkinson disease (PD) who underwent treatment involving embryonic cell implantation had better motor functioning after their procedures than PD patients who did not receive embryonic cells, according to an article in the June issue of the Archives of Neurology, one of the JAMA/Archives journals.

According to information in the article, PD is a neurodegenerative disorder without a known cause or cure. Embryonic nigral cell implantation places dopamine producing cells from embryos (called nigral cells) into the brains of patients with PD, whose own nigral cells no longer produce normal levels of dopamine. Lack of dopamine, a neurochemical involved in movement, is what causes the characteristic unsteady movements many patients with PD experience. Reaction time (RT) scores and motor time (MT) scores measure neural processing and can be used to assess motor functioning in patients with PD. These scores indicate the time it takes a patient to process a command and act on it - for example, touching a screen when prompted. Lower RT and MT scores are typical of patients with PD compared to patients without PD.

Paul H. Gordon, M.D., of NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, and colleagues measured changes in motor performance in patients (aged 35 to 76) with PD who received embryonic cell implants (n=20) and patients who had the surgery but received no embryonic cells (n=19). RT and MT measurements were taken before surgery, and at four and 12 months after surgery. Patients did not take any dopamine-boosting medications within 12 hours before the RT and MT evaluations.

The researchers found that the difference in average combined RT and MT scores between the sham surgery and implant groups was statistically significant and was greatest in those 60 years or older.

"The physiological measures detected significant changes in patients undergoing embryonic nigral cell implants and correlated directly with clinical outcome measures," the researchers write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 21, 2004
To contact Jennifer Rubin Grandis, M.D., call Jocelyn Uhl at 412/647-3555.

FEMALE OTOLARYNGOLOGISTS EARN LESS THAN THEIR MALE COUNTERPARTS

CHICAGO—Female otolaryngologists earn less money for performing similar jobs as male otolaryngologists, and women's increased family responsibilities may reduce opportunities for career advancement, according to an article in the June issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

According to information in the article, otolaryngology - the diagnosis and treatment of diseases of the head and neck - has traditionally been a male-dominated profession, but as the number of women entering medical school has increased, so have the percentages of women in subspecialty surgical careers, like otolaryngology.

Jennifer Rubin Grandis, M.D., of the University of Pittsburgh, and colleagues investigated career and lifestyle factors that may distinguish female otolaryngologists from their male peers.

The researchers sent questionnaires to all 502 female members of the American Academy of Otolaryngology—Head and Neck Surgery who finished their residency training and were practicing. For comparison, the survey also was sent to two male otolaryngologists (for each female survey recipient), who were matched on years since completion of training, geographic region and practice type. The researchers received responses from 673 otolaryngologists (52.6 percent response rate).

"Women were more likely to be divorced or separated and have fewer children," the authors write. They also found that women reduced their work hours when they had more children. When the researchers took into account professional practice hours and hours spent in the operating room per week, type of practice and years since completion of residency, they found that women earned 15 percent to 20 percent less per year than men.

Additionally, "Men relied more on their spouse or partner for household responsibilities and child care, and 34.3 percent of the women (compared with 7.1 percent of the men) spent 21 to 40 hours per week on household management," the authors write.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 21, 2004
To contact corresponding author Jeffrey E. Terrell, M.D., call Kara Gavin at 734/764-2220.

MANY PATIENTS WITH HEAD AND NECK CANCER ARE DISABLED BY THEIR CANCER TREATMENT

CHICAGO—More than half of head and neck cancer patients surveyed were disabled by their cancer or by cancer treatment, according to an article in the June issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

According to information in the article, more than 40,000 new cases of head and neck cancer are diagnosed annually in the United States, with 12,000 deaths each year. Patients with head and neck cancer often experience problems with eating and communicating, have pain, and have poor emotional well being and general functional status.

Joseph C. Taylor, M.D., of the University of Michigan, Ann Arbor, and colleagues studied 384 patients (89 percent male, 88 percent white) who were working prior to their diagnosis of head and neck cancer. Most patients (70 percent) had stage III or stage IV disease (advanced stages of cancer). Most patients (84 percent) had radiation treatment, and 58 percent had a neck dissection (neck surgery).

Of the 384 patients, 52 percent (n=201) were disabled by their cancer treatment. The researchers found that patients who underwent chemotherapy were 3.4 times as likely to be disabled, and patients who underwent neck dissection surgery were 2.3 times as likely to be disabled.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 21, 2004
To contact Brent C. Opmeer, Ph.D., e-mail:b.c.opmeer{at}amc.uva.nl.

COSTS OF USING TWO COMMON PSORIASIS TREATMENTS ARE COMPARABLE

CHICAGO—The difference in cost associated with using two common treatments for psoriasis over the course of one year with treatment lasting 16 weeks are small, according to an article in the June issue of the Archives of Dermatology, one of the JAMA/Archives journals.

Psoriasis is a chronic skin disease for which there is no cure. Methotrexate and cyclosporine are the two most common systemic (as opposed to topically applied) treatments for patients with moderate to severe psoriasis and have been used for the past 40 and 20 years, respectively. Both medications have been studied and are effective at minimizing psoriasis, however, their unit costs are different.

Brent C. Opmeer, Ph.D., from the University of Amsterdam, the Netherlands, and colleagues compared the direct and indirect medical costs and nonmedical costs of treating psoriasis with methotrexate (n=43) vs. cyclosporine (n=42) in 85 adult patients with moderate to severe psoriasis with no previous use of the two medications. Patients enrolled in the study between October 13, 1998 and June 15, 2000 and were treated for 16 weeks with an additional 36 weeks of follow-up. Direct costs were those generated by using health care resources (medication, diagnostic procedures, and visits to health care professionals). Indirect costs were associated with lost or impaired ability to work or to engage in leisure-time activities.

The researchers found that the average cumulative costs associated with 16 weeks of treatment with methotrexate were $1,593 and were $2,114 for 16 weeks of treatment with cyclosporine. During the 36 weeks of follow-up, costs were $2,418 for the methotrexate group and $2,306 for the cyclosporine group. The overall difference in annual cost was $409, about 10 percent of the total cost.

"After one year, the overall difference in total costs between methotrexate and cyclosporine for 16 weeks of treatment and follow-up is relatively small. Systemic medication costs are only a fraction of the costs directly and indirectly generated by utilization of health care resources and associated with individual patients rather than with methotrexate or cyclosporine," the authors write.