JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. the Archives of Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENTS
ARCHIVES OF INTERNAL MEDICINE NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 18, 2006)
ABOUT 5 PERCENT OF ADULTS WITH INSOMNIA USE ALTERNATIVE THERAPIES
INSUFFICIENT SLEEP ASSOCIATED WITH POORER BLOOD GLUCOSE CONTROL IN AFRICAN-AMERICANS
BREATHING PROBLEMS DURING SLEEP INCREASE RISK OF DEPRESSION
ALLERGIC RHINITIS ASSOCIATED WITH IMPAIRED SLEEP QUALITY
EDITORIAL: INCORPORATE SLEEP EVALUATION INTO ROUTINE MEDICAL CARE
ARCHIVES OF INTERNAL MEDICINE Audio Interviews
Interview with Philip Greenland, M.D., Editor of the Archives of Internal Medicine
Interview with Kristen L. Knutson, Ph.D., lead author of "Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus"
(Arch Intern Med. 2006;166:1768-1774.)
Interview with Nancy J. Pearson, Ph.D., lead author of "Insomnia, Trouble Sleeping, and Complementary and Alternative Medicine"
(Arch Intern Med. 2006;166:1775-1782.)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 18, 2006)
RISK FACTORS IDENTIFIED FOR HEARING LOSS IN CHILDREN WITH BACTERIAL MENINGITIS
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 18, 2006)
NASAL PLASTIC SURGERY IMPROVES AIRWAY FUNCTION
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 18, 2006)
SHORT-TERM TOPICAL CORTICOSTEROID USE MAY OFFER RELIEF FOR PATIENTS WITH ACUTE FORM OF CERTAIN TYPE OF PSORIASIS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, September 18, 2006)
TRANSFUSION-FREE SURGICAL PROGRAM DEVELOPED FOR JEHOVAH’S WITNESS PATIENTS HAS REDUCED USE OF BLOOD PRODUCTS FOR ALL PATIENTS UNDERGOING LIVER TRANSPLANTATION
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
Please Note: In conjunction with the release of the Archives of Internal Medicine theme issue on sleep and health, radio actualities from two of the researchers and an audio news story featuring the journal editor will be available in mp3 format on www.jamamedia.org at 3 p.m. CT on Monday, September 18.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Nancy J. Pearson, Ph.D., call the National Center for Complementary and Alternative Medicine press office at 301-496-7790.
ABOUT 5 PERCENT OF ADULTS WITH INSOMNIA USE ALTERNATIVE THERAPIES
CHICAGO—More than 1.6 million U.S. adults are estimated to use complementary and alternative therapies to treat insomnia or trouble sleeping, according to the results of a national survey published in the September 18 issue of Archives of Internal Medicine, a theme issue on sleep.
Approximately 10 to 34 percent of Americans regularly experience difficulty sleeping, also known as insomnia, according to background information in the article. Treatment options include prescription and non-prescription medications, antidepressants and cognitive behavioral therapy. Complementary and alternative medicine (CAM) therapies, defined as those practices that are not scientifically proven and are not currently considered part of conventional medicine, also are used to treat insomnia. Such therapies include herbal medicines and relaxation techniques.
Nancy J. Pearson, Ph.D., and colleagues at the National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, Md., analyzed data from a national survey of 31,044 adults conducted in 2002. Respondents answered one question about whether they had difficulty sleeping in the past 12 months and completed a 10-minute supplemental survey on the use of 27 types of CAM therapies. The interview also included questions about five other health conditions: depression and anxiety, congestive heart failure, diabetes, hypertension (high blood pressure) and obesity. Four items assessed behavior and motivation for using CAM therapies.
Of the adults interviewed, 17.4 percent reported that they had insomnia or trouble sleeping in the past year. Difficulty sleeping was more common in women than men, most prevalent between ages 45 and 64, and was associated with obesity, hypertension, congestive heart failure and anxiety or depression, but not diabetes. Of those with insomnia or trouble sleeping, 4.5 percent reported that they had used CAM to treat the condition, which is equal to about 1.62 million adults in the general population. Survey respondents who were younger and who had a higher level of education were more likely to use CAM to help them sleep; use of CAM was not related to having any of the five medical conditions studied.
Among those who use CAM therapies, 60.7 percent told their conventional physician. Sixty-five percent used biological methods, which include herbal medicines, diet interventions and vitamin therapy, and mind-body therapies such as meditation were used by 39 percent. Fifty-six percent reported that the therapy was very important to their health and well-being.
Forty-nine percent of those who used herbal medicine and 48 percent of those who used relaxation therapy reported that CAM helped alleviate their condition. “Although the question asking whether the CAM therapy helped provides useful information on the public’s perception of effectiveness of CAM therapies for insomnia or trouble sleeping, it does not directly address the efficacy of the CAM therapy,” the authors write. “A positive answer to this question could be due to a placebo effect, the natural history of the condition or other unidentified influences rather than efficacy of the CAM treatment.” The survey results provide valuable information about the use of CAM that can guide future studies of whether these therapies are effective, they conclude.
(Arch Intern Med. 2006;166:1775-1782. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was supported by the Division of Extramural Research and Training, National Center for Complementary and Alternative Medicine, National Institutes of Health, Department of Health and Human Services. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Please Note: Radio actualities from lead author Nancy J. Pearson, Ph.D., will be available in mp3 format at 3 p.m. CT on Monday, September 18.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact corresponding author Eve Van Cauter, Ph.D., call John Easton at 773-702-6241.
INSUFFICIENT SLEEP ASSOCIATED WITH POORER BLOOD GLUCOSE CONTROL IN AFRICAN-AMERICANS WITH DIABETES
CHICAGO—Getting fewer hours of sleep or lower-quality sleep may be associated with poorer blood glucose control among African-Americans with diabetes, according to an article in the September 18 issue of Archives of Internal Medicine, a theme issue on sleep.
Many individuals in modern society experience a chronic lack of adequate sleep, either because they voluntarily stay up late or because they have difficulty sleeping, according to background information in the article. Accumulating evidence suggests that restricting sleep may affect the ability of the body to process sugar (glucose) into energy, thereby increasing risk for the development of diabetes. Additional studies indicate that the reverse may be true, and that type 2 diabetes—which occurs when the body loses the ability to respond to the insulin that converts glucose into energy—may contribute to sleep problems.
Kristen L. Knutson, Ph.D., of the University of Chicago, and colleagues conducted a study of 161 African-Americans with type 2 diabetes, including 42 men and 119 women who had an average age of 57.3. During a 30- to 45-minute interview, participants answered questions about sleep quality and quantity, their diabetes and any complications, and whether or not they took insulin. Their waist-hip ratio was measured, and the patients reported their height and weight, from which body mass index (BMI) was calculated. Each individual was given a sleep quality score that ranged from zero to 21, with scores of greater than five indicating poor sleep quality. In addition, the researchers calculated a perceived sleep debt for each individual, described as the difference between the number of hours of sleep participants said they got on a typical weekday and the amount of sleep they said they wanted to get. Hemoglobin A1c (HbA1c) levels, which measure the control of blood glucose over time, were obtained from patients’ medical charts. A level of 7 percent or lower is the recommended optimal level for HbA1c.
The individuals in the study reported that they slept an average of six hours per night—22 percent averaged at least seven hours and only 6 percent at least eight hours. About 71 percent had sleep quality ratings of greater than five, indicating poor sleep quality. The average HbA1c level was 8.3 percent; 26 percent had a level below the recommended 7 percent.
Thirty-nine patients reported that their sleep was frequently disrupted by pain; these individuals were excluded from further analyses. Among the remaining 35 men and 87 women, 67 percent had poor sleep quality. Higher HbA1c levels were associated with lower sleep quality, less sleep and a larger perceived sleep debt, even after researchers controlled for sex, age, BMI, complications and use of insulin. Participants were then classified based on whether or not they had complications from diabetes and whether or not they used insulin. “In patients without complications, perceived sleep debt but not subjective sleep quality was associated with lnHbA1c levels,” authors write. “In contrast, in patients with at least one complication, [sleep quality] score, but not perceived sleep debt, was a significant predictor after controlling for covariates.”
The results do not indicate whether diabetes control impacts sleep—for instance, excessive urination at night resulting from high blood glucose levels could interrupt sleep—or whether insufficient or poor-quality sleep could contribute to poor glucose control. “Additional research is needed to determine whether optimizing sleep duration and quality may improve glucose control in patients with type 2 diabetes,” conclude Dr. Knutson and colleagues. “Sleep curtailment has become increasingly prevalent in modern society, and it cannot be excluded that this behavior has contributed to the current epidemic of type 2 diabetes.”
(Arch Intern Med. 2006;166:1768-1774. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was supported by grants from the MacArthur Foundation, Chicago; the American Diabetes Association, Alexandria, Va.; and the National Institutes of Health, Bethesda, Md. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Please Note: Radio actualities from lead author Kristen L. Knutson, Ph.D., will be available in mp3 format at 3 p.m. CT on Monday, September 18.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Paul E. Peppard, Ph.D., call Aaron Conklin at 608-263-5561.
BREATHING PROBLEMS DURING SLEEP INCREASE RISK OF DEPRESSION
CHICAGO—Individuals who have sleep-related breathing disorder appear significantly more likely to develop depression, with odds of depression increasing as breathing disorders becomes more severe, according to a study in the September 18 issue of Archives of Internal Medicine, a theme issue on sleep.
Frequent pauses in breathing, labored breathing or reduced breathing during the night are hallmark signs of sleep-related breathing disorder, according to background information in the article. The disorder has been linked to a variety of negative health consequences, including cardiovascular disease and difficulty functioning during the day. Previous studies have suggested that depression improves when sleep-related breathing disorder is treated, indicating that these two common conditions are related. Characterizing the relationship, the authors write, could “guide screening for depressive symptoms in patient populations with sleep-related breathing disorder, suggest strategies for managing sleep-related breathing disorder–related depression and alert clinicians about the possibility of untreated depression complicating adherence to sleep-related breathing disorder mitigation strategies and treatments ....”
Paul E. Peppard, Ph.D., and colleagues at the University of Wisconsin-Madison evaluated 1,408 adults (788 men, 620 women) who were between the ages of 30 and 60 at the beginning of the study, in 1988. The participants stayed overnight in a laboratory once every four years, during which time sleep was monitored with a test known as polysomnography and breathing disturbances were recorded. By May 2005, 449 participants had completed one sleep study, 382 completed two, 319 completed three and 258 completed four, for a total of 3,202 sleep studies. At each sleep study, body mass index was recorded and interviews and questionnaires completed by participants provided information about medical history, lifestyle habits, demographics and whether they had difficulty sleeping at night (insomnia) or felt sleepy during the day.
During the 3,202 sleep studies, 334 showed no evidence of reduced or paused breathing. Among cases of sleep-related breathing disorder, 1,911 were categorized as minimal, defined as an average of fewer than five incidences of reduced or paused breathing per hour; 606 were mild, with an average of five to 14 such events per hour; and 351 were moderate or worse, with 15 or more events per hour. About twice as many men as women had mild, moderate or worse sleep-related breathing disorder—14 percent of sleep studies among men revealed moderate sleep-related breathing disorder, vs. 6 percent of women. Throughout the study, there were 649 cases of mild depression and 392 of moderate or more severe depression. Women were about twice as likely to be depressed as men (27 percent vs. 15 percent).
Compared with patients without sleep-related breathing disorder, those with minimal cases of the condition were 1.6 times as likely to be depressed; those with mild cases, twice as likely; and those with moderate or worse, 2.6 times as likely. Individuals whose breathing problems worsened over time increased their risk for depression. “Among these studies, an increase in sleep-related breathing disorder to the next higher category (for instance, from no sleep-related breathing disorder to minimal sleep-related breathing disorder) was associated with a 1.8-fold increased odds for development of depression compared with unchanging sleep-related breathing disorder,” the authors write. “For example, persons initially without sleep-related breathing disorder but in whom minimal sleep-related breathing disorder developed during a four-year period are estimated to be at 80 percent greater odds for development of depression than those who remain without sleep-related breathing disorder.”
“Our longitudinal findings of a dose-response association between sleep-related breathing disorder and depression provide evidence consistent with a causal link between these conditions and should heighten clinical suspicion of depression in those with sleep-related breathing disorder,” they conclude.
(Arch Intern Med. 2006;166:1709-1715. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by grants from the National Institutes of Health. 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/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Damien Léger, M.D., e-mail damien.leger{at}htd.aphp.fr.
ALLERGIC RHINITIS ASSOCIATED WITH IMPAIRED SLEEP QUALITY
CHICAGO—Patients with allergic rhinitis, such as that caused by hay fever and other allergies, have more difficulty sleeping and more sleep disorders than those without allergies, according to a report in the September 18 issue of Archives of Internal Medicine, a theme issue on sleep.
Allergic rhinitis, which occurs when pollen or other allergens irritate and inflame the nasal passages, affects about 20 to 50 percent of the population, according to background information in the article. Allergies have been shown to affect quality of life and several studies have suggested that they may contribute to snoring and breathing problems during sleep, including sleep apnea, a temporary halt to breathing. However, few researchers have closely examined sleep disorders in patients with allergic rhinitis.
Damien Léger, M.D., of Assistance Publique Hôpitaux de Paris, and colleagues explored the association between allergic rhinitis and sleep in 591 patients (47 percent men, 53 percent women, average age 34) who had the condition for at least one year and who were being treated by an allergist or by an ear, nose and throat specialist. A control group of 502 individuals who were the same age and sex and lived in the same area, but did not have allergic rhinitis, was also assessed. In 2002, all participants reported sleep disorders and rated their sleepiness; they also provided details regarding demographics, socioeconomic status and smoking habits. For patients with allergic rhinitis, researchers recorded the type of allergies, the duration of the condition, symptoms experienced and treatments used, as well as the presence and treatment of any additional allergic disorders.
All sleep disorders and complaints—including insomnia, waking up during the night, snoring and feeling fatigued when awakening—were more common in those with allergic rhinitis, who also slept fewer hours, took longer to fall asleep and more often felt sleepy during the day. Among the 591 patients with allergic rhinitis, 41.6 percent (vs. 18.3 percent of those without allergic rhinitis) reported difficulty falling asleep, 63.2 percent said they felt they lacked adequate sleep (compared with 25.4 percent of controls) and 35.8 percent (vs. 16 percent of controls) reported insomnia. “The results show a significant impact of allergic rhinitis on all dimensions of sleep quality and, consequently, a lower quality of life as reflected by more somnolence [sleepiness]; daytime fatigue and sleepiness; and impaired memory, mood and sexuality, with a significantly increased consumption of alcohol and sedatives in cases compared with the control group,” the authors write.
The effects of allergic rhinitis on sleep became more pronounced when the condition was moderate to severe. As allergies worsened, individuals slept fewer hours at night, felt sleepy more often during the day, took longer to fall asleep and found it more necessary to take sedative drugs.
All types of physicians, including primary care physicians, pulmonologists and ear, nose and throat specialists, should question patients with allergic rhinitis about their sleep habits and difficulties, the authors conclude. “This could lead to early detection and treatment of sleep disorders in these patients,” they write. “Treating allergic rhinitis or other nasal symptoms may improve dramatically the quality of sleep. In the long term, such a strategy would have positive repercussions on a societal level; for example, the numbers of road and work accidents would be reduced. Considering the high incidence of allergic rhinitis and the high rate of associated sleep disorders, the issue is one of public health.”
(Arch Intern Med. 2006;166:1744-1748. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Department of Epidemiology, GlaxoSmithKline Laboratory. 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/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Phyllis C. Zee, M.D., Ph.D., call Tamara Field at 847-491-4888.
EDITORIAL: INCORPORATE SLEEP EVALUATION INTO ROUTINE MEDICAL CARE
Studies on Sleep and Health Highlighted in Archives of Internal Medicine Theme Issue
CHICAGO—Sleep is an integral part of health, and assessment of sleep habits should be a standard part of medical care, according to an editorial in the September 18 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The issue is devoted to studies of sleep and health.
“The theme that emerges throughout this issue is that sleep serves as an indicator of health and quality of life and therefore is highly and directly relevant to the practice of medicine,” write guest editor Phyllis C. Zee, M.D., Ph.D., and Fred W. Turek, Ph.D., of Northwestern University Feinberg School of Medicine, Chicago.
“Indeed, numerous studies have recently shown that sleep disorders are often comorbid with a broad range of medical and psychiatric conditions and also have a negative impact on health, mood and quality of life,” they continue. “Increasing evidence also points to a bidirectional relationship between sleep and health; that is, sleep disturbances contribute to the development of or increase the severity of various medical and psychiatric disorders, and these same disorders result in poor sleep quality.”
Research results published in this issue of Archives of Internal Medicine "further our understanding of the relationship of sleep and health," Drs. Zee and Turek write. Studies appearing in this issue find that:
- Fewer hours of sleep may contribute to poor health in young adults, according to an international survey of more than 17,000 university students
- Those in rural areas who sleep fewer hours appear to have a higher average body mass index
- The immune system may play a role in narcolepsy, a disorder marked by a sudden and uncontrollable urge to sleep
- Children with chronic illnesses, especially those on ventilators, tend to have parents with disrupted sleep
- The immune system may be affected by a lack of sleep, altering blood chemistry in a way that potentially contributes to inflammation and a variety of diseases
Over the past decade, it has become apparent that voluntarily limited sleep, as well as sleep disorders such as insomnia and restless legs syndrome, can negatively affect overall health—a connection emphasized by the increasing legitimacy of sleep medicine as a specialty. In addition, medications used to treat a number of physical and psychiatric disorders can affect sleep, making evaluation for sleep problems essential for those following such regimens. “At the very least, assessment of sleep quantity and quality should be integrated into the routine review of systems,” Drs. Zee and Turek conclude. “Sleep is an indicator of health, and sufficient sleep quantity and good quality should be considered as an essential component of a healthy lifestyle, as much as exercise and nutrition.”
(Arch Intern Med. 2006;166:1686-1688. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including author contributions and affiliations, financial disclosures, funding and support, etc.
Please Note: In conjunction with the release of the Archives of Internal Medicine theme issue on sleep and health, radio actualities from two of the researchers and an audio news story featuring the journal editor, Philip Greenland, M.D., will be available in mp3 format at 3 p.m. CT on Monday, September 18.
For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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ARCHIVES OF INTERNAL MEDICINE AUDIO INTERVIEWS
Interview with Philip Greenland, M.D., Editor of the Archives of Internal
Medicine
CLIP (mp3 file)
Transcript:
THIS IS MAVIS PRALL FOR THE ARCHIVES OF INTERNAL MEDICINE. HOW IMPORTANT IS SLEEP WHEN IT COMES TO YOUR OVERALL HEALTH? A NEW COLLECTION OF STUDIES SHOWS A BI-DIRECTIONAL RELATIONSHIP BETWEEN
SLEEP AND HEALTH.
"A bi-directional relationship means that sleep problems contribute to a number of medical or psychiatric disorders, and these same disorders result in sleep problems. So it's a vicious circle."
THAT'S DR. PHILIP GREENLAND, EDITOR OF THE ARCHIVES JOURNAL.
"Heart problems, breathing problems, chronic pain and depression all seem to be related to, and actually cause, sleep problems."
INSOMNIA AND OTHER SLEEP DISTURBANCES MAY ALSO INCREASE DIABETES AND OBESITY. DR. GREENLAND SAYS SLEEP IS FINALLY MAKING ITS WAY INTO THE MAINSTREAM OF MEDICINE.
"People should consider sleep quality just as important as exercise and nutrition. Doctors and their patients should work on treating sleep problems, so that overall health can be improved."
TALK WITH YOUR PHYSICIAN IF YOU HAVE QUESTIONS ABOUT YOUR SLEEP. THIS IS MAVIS PRALL FOR THE ARCHIVES OF INTERNAL MEDICINE.
Interview with Kristen L. Knutson, Ph.D., lead author of "Role of Sleep Duration and Quality in the Risk and Severity of Type 2 Diabetes Mellitus"
(Arch Intern Med. 2006;166:1768-1774.)
CLIP 1 (mp3 file)
CLIP 2 (mp3 file)
CLIP 3 (mp3 file)
Transcript:
Clip 1: We were interested in examining whether sleep duration or quality was related to controlling blood sugar among diabetics. We looked at this in a
sample of African Americans with Type 2 diabetes. Our sample of diabetics reported significantly shorter bed times than has been reported nationally in the U.S., and the majority of them reported
poor quality sleep. Runs :21
Clip 2: We found that poor quality sleep or insufficient sleep was associated with poor control of blood sugar levels. In other words, those who reported not sleeping well or not sleeping
enough had worse control of their diabetes. Runs :13
Clip 3: We can't tell from this study whether poor sleep impairs a person's ability to control their blood sugar, or whether poor control of blood sugar impairs a person's sleep. So future
studies need to try improving or extending the sleep of people with diabetes and see if their blood sugar levels improve. Runs :18
Interview with Interview with Nancy J. Pearson, Ph.D., lead author of
"Insomnia, Trouble Sleeping, and Complementary and Alternative Medicine" (Arch Intern Med. 2006;166:1775-1782.)
CLIP 1 (mp3
file)
CLIP 2 (mp3 file)
Transcript:
Clip 1: According to the survey, 4.5 percent, or over 1.6 million people, reported using CAM to treat insomnia or trouble sleeping. Runs :11
Clip 2: As part of the survey, we did ask whether herbal therapies or relaxation helped their insomnia and the majority of the people said that it did. But this is just their opinion and not a
scientific finding. Runs :14
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact corresponding author Carla Marie Giannoni, M.D., call Graciela Gutierrez at 713-798-4710.
RISK FACTORS IDENTIFIED FOR HEARING LOSS IN CHILDREN WITH BACTERIAL MENINGITIS
CHICAGO— Researchers have identified several risk factors that are associated with the development of hearing loss in children with bacterial meningitis, according to a study in the September issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Bacterial meningitis is the most common reason for acquired hearing loss, according to background information in the article. The researchers state that
"5 to 35 percent of patients with bacterial meningitis will develop permanent sensorineural hearing loss, and profound bilateral [both sides] hearing loss will occur in up to 4 percent of patients.
The resulting social and educational impairments can be devastating to the individual and society."
J. Walter Kutz, M.D., and colleagues from Baylor College of Medicine, Houston, reviewed the medical records of 171 children admitted to the Texas Children’s Hospital, Houston, with a diagnosis of bacterial meningitis from January 1992 to November 2002. The diagnosis of bacterial meningitis was made with positive cerebrospinal fluid (CSF). Audiologic testing was performed during the initial hospitalization, follow-up testing was available and findings were analyzed to predict the stability of hearing over time. The children ranged in age from three months to 17 years (average age 3.8 years).
“Of 134 patients who underwent audiologic testing during their initial hospitalization, 41 (30.6 percent) were found to have at least a unilateral mild sensorineural hearing loss,” the researchers found. “The incidence of hearing loss was greater in patients with Streptococcus pneumoniae meningitis than in patients with Neisseria meningitidis meningitis (35.9 percent and 23.9 percent, respectively).” “Length of hospitalization, development of seizures, elevated cerebrospinal fluid protein and decreased cerebrospinal fluid glucose were significant predictors for hearing loss in children with bacterial meningitis.”
“Identification of hearing loss in children with bacterial meningitis and early rehabilitation will lessen the long-term educational and social difficulties these children may experience,” the authors conclude.
(Arch Otolaryngol Head Neck Surg. 2006;132:941-945. Available to the media pre-embargo at www.jamamedia.org)
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/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Sam P. Most, M.D., call Ruthann Richter at 650-725-8047.
NASAL PLASTIC SURGERY IMPROVES AIRWAY FUNCTION
CHICAGO—Nasal plastic surgery appears to improve nasal airway function in patients with severe nasal obstructions, according to a report in the September/October issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.
Obstruction of the nasal passages is one of the most common conditions treated by otolaryngologists and facial plastic surgeons, according to background information in the article. Common causes include septal deviation, which occurs when the wall separating the two nasal passages is crooked or off-center; valve insufficiency, caused by improper positioning or collapse of cartilage inside the nasal passages; and turbinate hypertrophy, when air flow is blocked by large or swollen turbinates, areas inside the nose covered by mucous membranes that help warm and filter incoming air. Surgical procedures to treat these types of conditions are collectively known as functional rhinoplasty.
Sam P. Most, M.D., formerly of the University of Washington School of Medicine, Cosmetic Surgery Center, Seattle, and now at Stanford University, Calif., evaluated 41 patients (27 men, 14 women, average age 41.5) with severe nasal obstruction for at least one year who subsequently underwent functional rhinoplasty at the center. Patients completed preoperative and postoperative evaluations, including questionnaires designed to assess the severity of their nasal obstruction and their quality of life. Patients were each given a score from zero to 100, with higher scores indicating more severe nasal obstructions.
The average score decreased significantly after surgery, from 58.4 to 15.7 after an average of 227 days. The researcher also examined groups of patients according to the specific procedure performed—including spreader grafting, septoplasty and turbinectomy—and found similar rates of improvement.
“Functional rhinoplasty techniques are effective in improving nasal airway function as measured by a patient-based, disease-specific, quality-of-life instrument,” Dr. Most concludes. “The specific techniques considered to treat nasal obstruction can be tailored to address the areas of concern, including septal deviation, internal or external valve collapse and turbinate hypertrophy.”
(Arch Facial Plast Surg. 2006;8:306-309. Available to the media pre-embargo at www.jamamedia.org)
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/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Alexander Kreuter, M.D., email: a.kreuter{at}derma.de.
SHORT-TERM TOPICAL CORTICOSTEROID USE MAY OFFER RELIEF FOR PATIENTS WITH ACUTE FORM OF CERTAIN TYPE OF PSORIASIS
CHICAGO—Researchers suggest a short-term application of topical corticosteroids and maintenance with a less potent agent for patients with intertriginous psoriasis (IP), according to a study published in the September issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis is an inflammatory skin disease. In a subset of patients, psoriasis is located in the intertriginous areas, including the skin folds of the underarms, breasts, groin, buttocks and genitals, according to background information in the article. “Patients who exhibit intertriginous psoriasis often complain about intense itching, irritation from sweating and soreness. These symptoms may have devastating psychological and emotional consequences.” Management of IP usually includes the application of topical corticosteroids, but those medications have adverse effects with long-term use.
In this study, Alexander Kreuter, M.D, from Ruhr University of Bochum, Germany, and colleagues conducted a randomized controlled trial that compared 1 percent pimecrolimus (a new anti-inflammatory drug), 0.005 percent calcipotriol, 0.1 percent betamethasone and the vehicle (a similarly appearing cream with no active drug) in the treatment of IP with a four-week treatment period and a six-week follow-up without therapy. A total of 80 adult patients with the clinical diagnosis of IP were included, 20 patients in each of the four treatment groups.
“After four weeks of treatment, the three active compounds and the vehicle resulted in a significant decrease in mean (average) M-PASI score [Modified Psoriasis Area and Severity Index] (86.4 percent for 0.1 percent betamethasone, 62.4 percent for 0.005 percent calcipotriol, 39.7 percent for 1 percent pimecrolimus and 21.1 percent for vehicle),” the researchers found. “The 0.1 percent betamethasone was significantly more effective than 1 percent pimecrolimus during the study period.” The researchers report 25 percent of patients treated with pimecrolimus reported an increase in itching and burning shortly after application, however, most reactions lasted less than 30 minutes and resolved in a few days.
“In conclusion, this study indicated the efficacy of all three active compounds, 1 percent pimecrolimus, 0.1 percent betamethasone, and 0.005 percent calcipotriol (as well as the vehicle) in the treatment of IP. The 0.1 percent betamethasone was clearly more effective than 1 percent pimecrolimus, confirming that treatment with corticosteroids is still the most effective topical approach for psoriasis. However, their use in long-term management, particularly for the treatment of intertriginous areas, which are more prone to steroid adverse effects, is limited. To combine the rapid anti-inflammatory effects of a topical corticosteroid with the favorable long-term effects and safety profile of pimecrolimus or calcipotriol, short-term application of topical corticosteroids for acute disease followed by maintenance treatment with one of these agents seems to be a reasonable approach in the treatment of IP.”
(Arch Dermatol. 2006;142:1138-1143. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Co-author Dr. Bräutigam is an employee of Novartis Pharma GmbH. This study was supported by a financial grant from Novartis Pharma GmbH. 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/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 18, 2006
Media Advisory: To contact Nicolas Jabbour, M.D., call Brooke Osburn at 405-951-4821.
TRANSFUSION-FREE SURGICAL PROGRAM DEVELOPED FOR JEHOVAH’S WITNESS PATIENTS HAS REDUCED USE OF BLOOD PRODUCTS FOR ALL PATIENTS UNDERGOING LIVER TRANSPLANTATION
CHICAGO—Development of a transfusion-free surgical program for Jehovah’s Witness patients undergoing liver transplantation also has helped reduce the overall use of blood products for non-Jehovah’s Witnesses undergoing the procedure, according to a study in the September issue of Archives of Surgery, one of the JAMA/Archives journals.
“Orthotopic liver transplantation [in which a patient’s diseased liver is removed and a donor liver transplanted into the same place] is typically associated with a large volume of blood loss, resulting in multiple transfusions and related complications,” the authors describe in background information in the article. “Transfusion-free surgery is rapidly gaining much-needed attention primarily because of the concerns surrounding transmission of diseases such as human immunodeficiency virus, hepatitis C and other viral infections. Additionally, long-term shortage of blood products and a paucity of alternatives put the system under duress, resulting in cancellation or postponement of elective cases.”
Nicolas Jabbour, M.D., from the INTEGRIS Baptist Medical Center, Oklahoma City, and colleagues analyzed the medical records of 365 adult and pediatric orthotopic liver transplants performed from January 1997 through December 2004 at the University of Southern California-University Hospital in Los Angeles. The investigators evaluated the impact of the initiation of a transfusion-free program for Jehovah’s Witnesses undergoing liver transplantation on the overall use of blood products in non-Jehovah’s Witnesses undergoing the procedure. The pediatric and Jehovah’s Witness transplant recipients were eliminated from the study, leaving only adult non-Jehovah’s Witness patients who either received a liver transplant from a deceased donor or a living donor (n=272). These patients were categorized into two groups based on the initiation of the Transfusion-Free Medicine and Surgery Program at USC (for Jehovah’s Witnesses) in January 2000. Group 1 consisted of recipients who received the liver transplant before January 2000 and group 2 included all patients who underwent transplantation after January 2000.
“Recipients in group 1 underwent orthotopic liver transplants without intraoperative blood-saving or salvaging techniques, whereas all transplant recipients in group 2 underwent intraoperative cell salvage (ICS) and acute normovolemic hemodilution (ANH) whenever feasible,” the authors report. “ANH indicates a therapeutic initiative that involves simultaneously removing the patient’s blood and replacing it with nonblood products…”
“In comparing group 2 with group 1, the mean (average) MELD [model of end-stage liver disease] score was statistically significantly higher, whereas the mean number of intraoperative PRBC (packed red blood cells) and FFP (fresh frozen plasma) transfusions were significantly lower,” the authors report. The MELD score describes the survival probability of a patient with end-stage liver disease, with higher scores indicating sicker patients. “The number of preoperative and postoperative PRBC, FFP and platelet transfusions between the two groups was not statistically different.”
“The development of a transfusion-free surgical program for Jehovah’s Witness patients has had a positive impact on reducing the overall blood use in non-Jehovah’s Witness patients,” the authors note. According to the authors, autotransfusion decreases some of the complications of transfusions, such as transmission of unknown pathogens, and also helps to preserve blood bank resources, which consequently reduces the overall procedure cost. “Surgeons are the leading consumers of blood products, and it is important that we are leaders in promoting transfusion-free techniques. In conclusion, we propose that the recognized need to minimize the use of blood products be elevated to the same level as antibiotic and deep venous thrombosis prophylaxis (prevention).”
(Arch Surg. 2006;141:913-917. Available to the media pre-embargo at www.jamamedia.org)
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/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at}jama-archives.org.
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