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 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 CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, August 22, 2006)
JAMA NEWS RELEASES
LESS EXPENSIVE ANTI-CLOTTING MEDICATION APPEARS AS SAFE AND EFFECTIVE AS MORE EXPENSIVE TREATMENT OPTION
PREVALENCE OF HERPES SIMPLEX VIRUS TYPE 2 IN U.S. DECREASING
METABOLIC DISORDER NOT WELL-SUITED FOR INCLUSION IN NEWBORN SCREENING PROGRAMS
REPORT ISSUED ON OUTBREAK OF SERIOUS EYE INFECTION LINKED WITH USE OF CERTAIN CONTACT LENS SOLUTION
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
CONTACT LENS SOLUTION LINKED TO EYE INFECTION — RESEARCHERS SAY PROPER LENS HYGIENE IS BEST DEFENSE
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
PLEASE NOTE: Because JAMA does not publish on the 5th Wednesday of a month, there will be no JAMA or news releases for August 30.
TV Note: This week's JAMA video news release is on the risk of an eye infection from use of a certain contact lens solution. The release will be fed Tuesday, August 22, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band), Downlink Freq: 3920 MHz Vertical, Audio: 6.20/6.80. For more information, call 312/464-JAMA (5262).
Please Note: The FOR THE MEDIA Web site 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
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 22, 2006
Media Advisory: To contact Clive Kearon, M.B., Ph.D., call Veronica McGuire at 905-525-9140, ext. 22169. To contact editorial author Jeffrey L. Carson, M.D., call Patricia Hansen at 732-235-6307.
LESS EXPENSIVE ANTI-CLOTTING MEDICATION APPEARS AS SAFE AND EFFECTIVE AS MORE EXPENSIVE TREATMENT OPTION
CHICAGO—Subcutaneous (beneath the skin) injection of the original and less expensive form of the anticoagulant medication heparin is as effective and safe as subcutaneous administration of the newer and more expensive low-molecular-weight heparin for treatment of venous thromboembolism (blood clots in the deep veins of the legs or in the lungs), according to a study in the August 23/30 issue of JAMA.
Heparin is used to treat thromboembolism, formation of a blood clot in a blood vessel. When unfractionated (regular) heparin is used in the treatment, it is usually administered intravenously with coagulation monitoring, which requires hospitalization. The standard approach includes ongoing dose adjustment in response to measurements of the APTT, a test that measures how well and fast the blood clots, and is used to determine the most effective dosage, according to background information in the article. Low-molecular-weight heparin administered by subcutaneous (under the skin) injection in fixed weight-adjusted doses is gradually replacing unfractionated heparin, according to background information in the article.
Clive Kearon, M.B., Ph.D., of McMaster University and the Henderson Research Centre, Hamilton, Ontario, and colleagues conducted a randomized trial to determine if fixed-dose subcutaneous unfractionated heparin is as effective and safe as low-molecular-weight heparin for treatment of venous thromboembolism. The study was conducted from September 1998 through February 2004 at six university-affiliated clinical centers in Canada and New Zealand. About 70 percent of both groups were treated as outpatients. All patients received three months of warfarin (an anticoagulant drug) therapy. Patients received either unfractionated or low-molecular-weight heparin administered subcutaneously.
Recurrent thromboembolism occurred in 3.8 percent of 345 patients in the unfractionated heparin group and in 3.4 percent of 352 patients in the low-molecular weight heparin group. The rate of major bleeding was comparable in the two groups.
The authors estimate that drug costs for a six-day course of treatment with low-molecular-weight heparin would be $712, while unfractionated heparin would cost $37 – assuming both drugs are administered in the regimens used in the study. “Because unfractionated heparin costs less than low-molecular-weight heparin, the unfractionated heparin regimen is attractive for clinical practice,” they write.
“We conclude that fixed-dose subcutaneous unfractionated heparin is as effective and safe as low-molecular-weight heparin for initial treatment of patients with venous thromboembolism and is suitable for treatment at home,” they write. “In addition, the results of this study question the value of APTT monitoring in patients who are treated with currently recommended doses of unfractionated heparin.”
(JAMA. 2006;296:935-942. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was supported by the Heart and Stroke Foundation of Ontario. Dr. Kearon and co-author James Douketis, M.D., were supported by the Heart and Stroke Foundation of Canada. Co-author Jeffrey S. Ginsberg, M.D., was supported by the Heart and Stroke Foundation of Ontario. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: ISSUES OF EFFICIENCY AND COST
In an accompanying editorial, Jeffrey L. Carson, M.D., of UMDNJ-Robert Wood Johnson Medical School, New Brunswick, N.J., writes that the question physicians must now answer is whether the evidence in the trial conducted by Kearon and colleagues is strong enough to change practice.
“Since the study by Kearon et al is the first trial to demonstrate that monitoring of APTT is not required, the results must be replicated using an adequately powered, double-blind trial design (in which neither physicians or patients know which anticoagulant the patient is receiving) before this approach can be adopted widely in clinical practice,” he writes.
“If the patient can be observed very closely, this treatment regimen might be used very cautiously in carefully selected patients who prefer outpatient treatment of venous thromboembolism and cannot afford the expense of low-molecular-weight heparin,” he continues.
“However, more than one study that demonstrates efficacy of this new treatment regimen is necessary before changing the management strategy for this potentially lethal disease,” he concludes.
(JAMA. 2006;296:991-993. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Financial disclosures – none reported.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 22, 2006
Media Advisory: To contact Fujie Xu, M.D., Ph.D., call the CDC’s Division of Media Relations at 404-639-3286.
PREVALENCE OF HERPES SIMPLEX VIRUS TYPE 2 IN U.S. DECREASING
CHICAGO—It appears the recent trend in the increasing prevalence of herpes simplex virus type 2 in the U.S. has been reversed, with a reported decrease in the proportion of people infected with the virus, according to a study in the August 23/30 issue of JAMA. The prevalence of herpes simplex virus type 1 also decreased, but the incidence of genital herpes caused by this virus may be increasing.
Herpes simplex virus type 2 (HSV-2) is the cause of most genital herpes and is one of the most prevalent sexually transmitted infections worldwide, according to background information in the article. Herpes simplex virus type 1 (HSV-1) is typically transmitted during childhood via nonsexual contact. HSV-1 has emerged as a principle causative agent of genital herpes in some developed countries. Both HSV-1 and HSV-2 can cause infrequent but serious diseases such as blindness, encephalitis (inflammation of the brain), and neonatal (the first four weeks after birth) infections.
Data from National Health and Nutrition Examination Surveys (NHANES) during 1976-1980 (NHANES II) and 1988-1994 (NHANES III) indicated that the overall seroprevalence (the number of persons in a population who test positive for a specific disease based on blood serum specimens) of HSV-2 in the U.S. increased by 30 percent, while the overall HSV-1 seroprevalence was unchanged.
Fujie Xu, M.D., Ph.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues examined national trends in HSV-1 and HSV-2 seroprevalence in the 1999-2004 survey compared with the 1988-1994 survey. The analyses included 11,508 persons from the 1999-2004 survey and 9,165 persons from the 1988-1994 survey who were age 14 to 49 years.
The researchers found that the overall age-adjusted HSV-2 seroprevalence was 17.0 percent in 1999-2004 and 21.0 percent in 1988-1994, a relative decrease of 19.0 percent between the 2 surveys. Decreases in HSV-2 seroprevalence were especially concentrated in persons aged 14 to 19 years between 1988 and 2004. Among those infected with HSV-2, the percentage who reported having been diagnosed with genital herpes was statistically different (14.3 percent in 1999-2004 and 9.9 percent in 1988-1994).
The authors write that the reasons that HSV-2 seroprevalence significantly decreased even after accounting for changes in measured sexual behaviors may include a combination of unmeasured factors, such as careful partner selection, condom use, and/or choosing oral sex over vaginal sex.
Seroprevalence of HSV-1 decreased from 62.0 percent in 1988-1994 to 57.7 percent in 1999-2004, a relative decrease of 6.9 percent between the 2 surveys. Among persons infected with HSV-1 but not with HSV-2, a higher percentage reported having been diagnosed with genital herpes in 1999-2004 compared with 1988-1994 (1.8 percent vs. 0.4 percent, respectively).
The researchers add that a decrease in HSV-1 seroprevalence in the United States is not unexpected due to improvements in living and hygiene conditions.
“The ability to monitor HSV-1 seroprevalence along with HSV-2 seroprevalence in NHANES is important for the development of HSV-2 prevention strategies, such as those related to vaccination. The changes in HSV-1 and HSV-2 seroprevalence will also directly affect the cause of neonatal herpes. Future studies are needed to monitor the changing HSV-1 and HSV-2 trends and to develop effective strategies to prevent HSV infection,” the authors conclude.
(JAMA. 2006;296:964-973. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This study was funded exclusively by the U.S. Centers for Disease Control and Prevention. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 22, 2006
Media Advisory: To contact Bianca T. van Maldegem, M.D., email: b.t.vanmaldegem{at}amc.uva.nl. To contact editorial author Susan E. Waisbren, Ph.D., call Anna Gonski at 617-355-6420.
METABOLIC DISORDER NOT WELL-SUITED FOR INCLUSION IN NEWBORN SCREENING PROGRAMS
CHICAGO—A metabolic disorder that can lead to developmental delay and other problems is more common than previously assumed, but does not meet major criteria for inclusion in newborn screening programs at this time, according to a study in the August 23/30 issue of JAMA.
Short-chain acyl-coenzyme A dehydrogenase deficiency (SCADD) is a condition in which the body cannot oxidize fatty acids because an enzyme is either missing or not functioning correctly. The clinical signs and symptoms of SCADD include developmental delay, hypoglycemia (low blood sugar levels), and epilepsy, according to background information in the article. It is an autosomal recessive disorder, which means the gene defect for SCADD only emerges when it is passed on to a child from both parents who carry the faulty gene. Screening for SCADD is included in expanded newborn screening programs in most U.S. and Australian states.
Bianca T. van Maldegem, M.D., of the University of Amsterdam, the Netherlands, and colleagues conducted a retrospective study involving 31 Dutch SCADD patients diagnosed between January 1987 and January 2006, and eight SCADD relatives. The focus of the study was to describe the genetic, biochemical, and clinical characteristics of SCADD patients and their relatives, and to explore the relation of genotype (the genetic constitution) to phenotype (the expressed features).
The researchers calculated a birth-prevalence of at least 1:50,000. “Most patients presented before the age of three years, with non-specific, generally uncomplicated, and often transient symptoms,” they write. “Developmental delay, epilepsy, behavioral disturbances, and hypoglycemia were the most frequently reported symptoms.”
The study did not reveal an association between the genotype and the clinical features in SCADD.
“Because SCADD does not meet major newborn screening criteria, it is not suited for inclusion in newborn screening programs at this time,” the authors conclude.
(JAMA. 2006;296:943-952. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: This work was supported by a research grant to Dr. van Maldegem and co-author Frits A. Wijburg, M.D., Ph.D., from the “Metabole Fonds” of the Academic Medical Center, Amsterdam. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: NEWBORN SCREENING FOR METABOLIC DISORDERS
In an accompanying editorial, Susan E. Waisbren, Ph.D., of Children’s Hospital Boston, writes that the study by van Maldegem and colleagues provides useful information on this issue, but their data do not provide enough information to rationalize the exclusion of SCADD from screening panels.
“Long-term studies comparing children identified by newborn screening with clinically identified children are needed,” she writes. “In addition to laboratory and genetic tests, long-term follow-up studies should include objective measures of outcome, such as growth, nutritional status, physical well-being, number of hospitalizations, number of emergency department visits, intelligence quotient levels, academic achievement, behavioral characteristics, language development, and motor skills.”
“Only through comprehensive, long-term research will a rational, fair, and universal newborn screening policy become reality,” she concludes.
(JAMA. 2006;296:993-995. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Dr. Waisbren receives grant support from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. Dr. Waisbren’s research on parental response and child outcomes in newborn screening is supported by the National Institutes of Health, Human Genome Project, Division of Ethical, Legal, and Social Implications.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, August 22, 2006
Media Advisory: To contact Douglas C. Chang, M.D., call the CDC’s Division of Media Relations at 404-639-3286.
REPORT ISSUED ON OUTBREAK OF SERIOUS EYE INFECTION LINKED WITH USE OF CERTAIN CONTACT LENS SOLUTION
CHICAGO—Researchers have additional information concerning the recent outbreak of the corneal infection Fusarium keratitis, which was associated with use of a specific contact lens solution, according to a study in the August 23/30 issue of JAMA. After preliminary findings from this investigation were released in May, the product was withdrawn from the market worldwide.
Among the estimated 34 million contact lens wearers in the United States, microbial keratitis (corneal infection) is a rare but serious complication that may lead to permanent vision loss or the need for corneal transplantation. The annual incidence of microbial keratitis is estimated to be 4 to 21 per 10,000 soft contact lens wearers depending on overnight wear, according to background information in the article. Fusarium is a filamentous fungus commonly found in soil and plants and is the major cause of fungal keratitis in certain tropical or subtropical regions. Beginning in March, 2006, the Centers for Disease Control and Prevention received multiple reports of Fusarium keratitis among contact lens wearers in the U.S.
Douglas C. Chang, M.D., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to determine the specific activities, contact lens hygiene practices, or products associated with this outbreak. Data for cases that occurred after June 1, 2005, were obtained by patient and ophthalmologist interviews for case patients and neighborhood-matched controls by trained personnel.
As of June 30, 2006, the researchers had identified 164 confirmed case patients with Fusarium keratitis in 33 states and 1 U.S. territory. Corneal transplantation was required or planned in 55 (34 percent). One hundred fifty-four (94 percent) of the confirmed case patients wore soft contact lenses. Forty-five case patients and 78 controls were included in the case-control study. In the final analysis, case patients were more than 20 times more likely than controls to report using a specific contact lens solution, ReNu with MoistureLoc. The prevalence of reported use of ReNu MultiPlus solution was similar between case patients and controls. Fusarium was not recovered from the factory, warehouse, solution filtrate, or unopened solution bottles; production of implicated lots was not clustered in time.
“Other products, including ReNu MultiPlus, private label Multiplus were not associated with Fusarium keratitis compared with nonusers of those solutions,” the authors write.
“Our findings, together with the results of environmental testing, suggest that exposure to Fusarium was likely the result of extrinsic contamination of contact lens solution bottles or lens cases occurring outside of the manufacturing or storage processes, perhaps in patients’ homes. However, suboptimal contact lens hygiene practices appear unlikely as the major explanation for the outbreak,” the researchers write.
“On-going studies may help to determine if the infections were caused by an interaction of its ingredients with Fusarium that might have permitted growth of the organism. In the meantime, clinicians should be vigilant in diagnosing and treating fungal keratitis, and users of MoistureLoc should discontinue the use of this product. Soft contact lens users should follow the instructions of their ophthalmologist or other eye-care professional and continue to pay careful attention to optimal hygiene practices, including washing and drying hands prior to handling lenses, storing lenses in new contact lens solution after each use, and carefully following directions for use of contact lens and contact lens solution products,” the authors conclude.
(JAMA. 2006;296:953-963. Available pre-embargo to the media 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 the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
CONTACT LENS SOLUTION LINKED TO EYE INFECTION — RESEARCHERS SAY PROPER LENS HYGIENE IS BEST DEFENSE
VIDEO:
B-ROLL
Still image of ReNu with MoistureLoc provided by Bausch and Lomb
Still image of eye infected with fusarium keratitis provided by Bascom Palmer Eye Institute
AUDIO:
THIS IS RENU WITH MOISTURELOC... A CONTACT LENS CLEANING SOLUTION THAT WAS TAKEN OFF THE MARKET IN MAY AFTER SOME PEOPLE USING IT GOT A PAINFUL EYE INFECTION CALLED FUSARIUM (fyou-SAIR-ee-um) KERATITIS (care-uh-TIGHT-iss).
VIDEO:
SOT/FULL
@ :11
Super: Benjamin Park, M.D.
U.S. Centers for Disease Control and Prevention
Runs :09
AUDIO:
“This fusarium fungus is very common and is in fact everywhere in the environment. It’s very commonly found in bathrooms and sinks and other water sources.”
VIDEO:
B-ROLL
Bite runs through name
Exterior of CDC from CDC tape
Pan from LCD screen/chart to Dr. Park and colleagues
GFX/JAMA COVER
AUDIO:
DR. BENJAMIN PARK AND HIS COLLEAGUES AT THE U.S. CENTERS FOR DISEASE CONTROL AND PREVENTION COLLABORATED WITH HEALTH OFFICIALS FROM THIRTY-THREE STATES, AND WITH THE FOOD AND DRUG ADMINISTRATION, TO INVESTIGATE THE FUSARIUM INFECTION OUTBREAK. THEIR FINDINGS APPEAR IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Benjamin Park, M.D.
U.S. Centers for Disease Control and Prevention
Runs :13
AUDIO:
“There were 164 confirmed cases of fusarium keratitis and we found that users of Bausch and Lomb’s MoistureLoc solution were over 20 times more likely to get this infection than people who didn’t use this solution.”
VIDEO:
B-ROLL
Still image of eye infected with fusarium keratitis provided by Bascom Palmer Eye Institute
More researchers discussing charts/graphs in conference room
Still image of ReNu with MoistureLoc provided by Bausch and Lomb
AUDIO:
IN ABOUT ONE-THIRD OF THE CASES, THE INFECTION WAS SO SEVERE THAT PATIENTS REQUIRED A CORNEAL TRANSPLANT TO PREVENT BLINDNESS. INVESTIGATORS FOUND NO CONTAMINATION IN THE MANUFACTURING PROCESS, OR IN ANY OF THE CONTACT LENS PRODUCTS THEY TESTED, SO WHAT’S THE LINK BETWEEN MOISTURELOC SOLUTION AND THIS INFECTION?
VIDEO:
SOT/FULL
Benjamin Park, M.D.
U.S. Centers for Disease Control and Prevention
Runs :09
AUDIO:
“That is really the subject of more research, to figure out exactly what it is about the composition of the solution that allows the fusarium fungus to grow.”
VIDEO:
B-ROLL
Man cleaning contact lens
Michael Ward walking down hall
AUDIO:
DR. PARK SAYS REGARDLESS OF THE SOLUTION, PRACTICE PROPER LENS CLEANING AND CARE. CONTACT LENS EXPERT MICHAEL WARD AGREES.
VIDEO:
SOT/FULL
@ 1:24
Super: Michael Ward, FCLSA, M.M.Sc.
Emory Eye Center
Runs :11
AUDIO:
“Infections are rare and they’re usually caused by a breakdown in hygienic practice. Of course the number one thing everyone needs to do is wash their hands prior to ever touching the contact lens.”
VIDEO:
B-ROLL
More man cleaning lens, putting it back in his eye
Still image of eye infected with fusarium keratitis provided by Bascom Palmer Eye Institute
AUDIO:
HE SAYS THIS MUCH IS CLEAR TO SEE: FOLLOWING YOUR DOCTOR’S INSTRUCTIONS FOR USAGE, CARE AND CLEANING OF YOUR LENSES WILL HELP PROTECT YOUR EYES FROM INFECTION. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
