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 DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 19, 2007)
STUDY EXAMINES SKIN DISORDERS IN CONSTRUCTION WORKERS FOLLOWING HURRICANES KATRINA AND RITA
ASIAN MEN WHO SMOKE MAY HAVE INCREASED RISK FOR HAIR LOSS
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 19, 2007)
SOLDIERS’ FACIAL FRACTURES CAN BE REPAIRED IN WAR ZONES
EDITORIAL: COLLABORATION BETWEEN MEDICAL SPECIALTIES BENEFITS PATIENTS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 19, 2007)
NEW ORGAN ALLOCATION CRITERIA ASSOCIATED WITH DECREASED DEATHS ON LIVER TRANSPLANT WAITING LIST
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 19, 2007)
TONSILLECTOMY ASSOCIATED WITH IMPROVED SLEEP AND BEHAVIOR IN CHILDREN WITH SLEEP-RELATED BREATHING DISORDERS
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 19, 2007
Media Advisory: To contact Rebecca Noe, M.P.H., call the CDC press office at 404-639-3286.
STUDY EXAMINES SKIN DISORDERS IN CONSTRUCTION WORKERS FOLLOWING HURRICANES KATRINA AND RITA
CHICAGO—Four distinct skin disorders were found in construction workers who helped repair buildings after Hurricane Katrina and Hurricane Rita, according to a report in the November issue of Archives of Dermatology, one of the JAMA/Archives journals.
Outbreaks of skin diseases frequently occur following hurricanes and flooding, but few of these outbreaks have been thoroughly investigated, according to background information in the article. "Hurricane Katrina made landfall on Aug. 29, 2005, and Hurricane Rita on Sept. 24, 2005. Syndromic surveillance in New Orleans, Louisiana, following these hurricanes indicated that 22 percent of diseases treated were dermatologic conditions (i.e., skin or wound infections and rashes)."
Rebecca Noe, M.P.H., at the Centers for Disease Control and Prevention, Atlanta, and colleagues analyzed the results of surveys, skin biopsy specimens and the environmental exposures of 136 civilian construction workers working and living at a New Orleans military base between August 2005 and October 2005. Many of these workers lived in wooden huts and tents with limited sanitation facilities.
"Of 136 workers, 58 reported rash, yielding an attack rate of 42.6 percent," the authors write. Forty-one (70.7 percent) of those who reported a rash were examined for diagnosis. Twenty-seven (65.9 percent) were found to have papular urticaria, a sensitivity reaction to insect bites resulting in solid raised bumps on the skin; eight (19.5 percent) had bacterial folliculitis, an infection causing inflammation around the hair follicles; six (14.6 percent) had fiberglass dermatitis, an irritation and inflammation of the skin from contact with fiberglass; and two (4.9 percent) had brachioradial photodermatitis, an abnormal skin reaction to sunlight causing irritation and burning in the arms.
Workers who were Native American, worked as roofers or slept in huts that had sustained flooding during Hurricane Katrina were more likely to suffer from papular urticaria than other workers. Native American workers were also more likely to develop fiberglass dermatitis than workers of another race.
"A suspected mite infestation of flooded housing units is the most plausible hypothesis, although we were unable to identify the arthropod [such as insects, spiders and scorpions] source," the authors conclude. "People working and living in post-hurricane environments where flooding has occurred may be at an increased risk of exposure to arthropods. To reduce dermatologic morbidity, we suggest avoiding flooded areas, fumigating with an acaricide [pesticide], wearing protective clothing and using arthropod repellant."
(Arch Dermatol. 2007;143(11):1393-1398. 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, November 19, 2007
Media Advisory: To contact corresponding author Tony Hsiu-Hsi Chen, D.D.S., Ph.D., e-mail: chenlin{at}ntu.edu.tw.
ASIAN MEN WHO SMOKE MAY HAVE INCREASED RISK FOR HAIR LOSS
CHICAGO—Smoking may be associated with age-related hair loss among Asian men, according to a report in the November issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Androgenetic alopecia, a hereditary androgen-dependent disorder, is characterized by progressive thinning of the scalp hair defined by various patterns," the authors write as background information in the article. "It is the most common type of hair loss in men." Although risk for the condition is largely genetic, some environmental factors also may play a role.
Lin-Hui Su, M.D., M.Sc., of the Far Eastern Memorial Hospital, and Tony Hsiu-Hsi Chen, D.D.S., Ph.D., of National Taiwan University, Taipei, surveyed 740 Taiwanese men age 40 to 91 (average age 65) in 2005. At an in-person interview, the men reported information about smoking, other risk factors for hair loss and if they had alopecia, the age at which they began losing their hair. Clinical classifications were used to assess their degree of hair loss, their height and weight were measured and blood samples were provided for analysis.
The men’s risk for hair loss increased with advancing age, but remained lower than the average risk among white men. "After controlling for age and family history, statistically significant positive associations were noted between moderate or severe androgenetic alopecia and smoking status, current cigarette smoking of 20 cigarettes or more per day and smoking intensity," the authors write.
This association could be caused by several mechanisms, they note. Smoking may destroy hair follicles, damage the papilla that circulate blood and hormones to stimulate hair growth or increase production of the hormone estrogen, which may counter the effects of androgen.
"Patients with early-onset androgenetic alopecia should receive advice early to prevent more advanced progression," the authors conclude.
(Arch Dermatol. 2007;143(11):1401-1406. 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 17, 2007
Media Advisory: To contact Manuel A. Lopez, M.D., call Sue Campbell at 210-292-7074.
SOLDIERS’ FACIAL FRACTURES CAN BE REPAIRED IN WAR ZONES
CHICAGO—American military personnel with facial fractures who meet certain criteria can undergo surgery to treat their injuries without being evacuated from war zones, according to a report in the November/December issue of Archives of Facial Plastic Surgery, a theme issue on orbital and ophthalmic plastic surgery.
Up to 61 percent of all patients wounded during Operation Iraqi Freedom have had a head and neck injury, according to background information in the article. "Prior to May 2005, most American military personnel with facial fractures were air evacuated from the Iraqi theater for definitive treatment of their facial fractures," the authors write. "Concerns about sterility, infection with Acinetobacter baumannii (a bacteria that has infected wounds and prostheses and caused catheter-related sepsis in many troops returning home) and delaying evacuation out of theater were all reasons cited for not definitively repairing facial fractures in theater."
Beginning in May 2005, American soldiers meeting strict guidelines underwent repair of their facial fractures by a procedure known as open reduction and internal fixation, which involves using mesh implants or plates to mend broken bones. Candidates for having the operation in Iraq met the following criteria:
- Their fracture was exposed either by a wound or by another procedure already being performed.
- Treating them in Iraq would not delay their evacuation from the theater of war.
- Treatment would allow them to remain in Iraq.
Manuel A. Lopez, M.D., and Jonathan L. Arnholt, M.D., of the Wilford Hall Medical Center, San Antonio, reviewed the records of 207 patients taken to the operating room by the otolaryngologist–facial plastic surgeon at the 322nd Expeditionary Medical Group at the Air Force Theater Hospital, Balad Air Base, Iraq from May to September 2005. The hospital is located in the Sunni Triangle, approximately 40 miles north of Baghdad.
A total of 175 patients (85 percent) were operated on for traumatic injury and 52 patients required open reduction and internal fixation of a facial fracture. Of these 52 patients, 17 were American military personnel who underwent an open reduction and internal fixation. An average of 8.3 months later, 16 of them were contacted or followed up on the global military medical database.
"None of these patients developed an Acinetobacter baumannii infection or had a complication caused by the definitive in-theater open reduction and internal fixation," the authors write. Only one patient required revision surgical repair due to high pressure in the skull.
"The practice of definitively treating facial fractures in a war zone using the criteria discussed in this article can lead to improved patient outcomes," the authors write. "It has been shown that a delay in fracture fixation can lead to both increased technical difficulties and infectious complications." An untreated fracture can become more difficult to repair because the surrounding facial muscles are fibrous and frequently contract. Complications such as nerve weakness and misaligned teeth are more prevalent in jaw fractures with delayed treatment, they note.
"Primary closure of soft tissue defects by open reduction and internal fixation of facial fractures on initial presentation to a well-equipped, in-theater hospital decreases the need for further facial surgery for patients when they return to the United States," they conclude.
(Arch Facial Plast Surg. 2007;9(6):400-405. 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, September 17, 2007
Media Advisory: For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
EDITORIAL: COLLABORATION BETWEEN MEDICAL SPECIALTIES BENEFITS PATIENTS
Trend toward less invasive procedures highlighted in ARCHIVES OF FACIAL PLASTIC SURGERY, ARCHIVES OF OPHTHALMOLOGY joint theme issue
CHICAGO—Opportunities for interdisciplinary cooperation between facial plastic surgeons and ophthalmologists have never been more important or promising, according to an editorial in the November/December issue of Archives of Facial Plastic Surgery, a theme issue on orbital and ophthalmic plastic surgery. The December issue of the journal Archives of Ophthalmology is a paired theme issue on the same topic, highlighting the value of multidisciplinary collaboration, writes Robert A. Goldberg, M.D., of the Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles.
"Great advancements (not to mention great collegial friendships) can be made when the ideas of our two proud specialties of ophthalmology and otolaryngology–head & neck surgery commingle in our thought processes, grooved (some would say ‘rutted’) by the long steeping of our separate training, and allow us to arrive at fresh approaches to the clinical problems that overlap our specialties’ boundaries," Dr. Goldberg writes.
Working together, these specialties have developed treatments and surgical techniques that are less invasive, he continues. Papers published in this issue of Archives of Facial Plastic Surgery find that:
- Patients with cancer in their nasal cavities can be treated with a combination of chemoradiation and surgery that spares their eyes, and most patients retain visual function.
- A new technique allows surgeons access to the side wall of the eye socket from top to bottom while preserving the muscles and tendons that support the eyelid.
- An injectable solution provides a new, safe, simple, technique to increase orbital volume in patients with eye prosthesis.
"Multidisciplinary collaboration between specialties, in my experience, provides enormous opportunities to advance our knowledge individually and as a discipline," Dr. Goldberg concludes. "The excellent contributions to both Archives journals in these joint theme issues proves my point."
(Arch Facial Plast Surg. 2007;9(6):384, 406-411, 419-426 and 439-442. 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.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 19, 2007
Media Advisory: To contact corresponding author C. Wright Pinson, M.D., M.B.A., call Craig Boerner at 615-343-7421.
NEW ORGAN ALLOCATION CRITERIA ASSOCIATED WITH DECREASED DEATHS ON LIVER TRANSPLANT WAITING LIST
CHICAGO—Changing the method by which donated livers are allocated to potential transplant patients appears to have decreased the number of deaths among individuals on the waiting list as well as shortened the time to transplantation, according to a report in the November issue of Archives of Surgery, one of the JAMA/Archives journals.
Since 1991, the number of liver transplantation candidates on the waiting list for donor organs has increased by a factor of ten, while the number of donor livers has only doubled, according to background information in the article. In 1998, four categories of medical urgency were established to prioritize patients with end-stage liver disease on the waiting list; as the list lengthened, duration on the list became the major way to sort patients within each category. On Feb. 27, 2002, the Model for End-stage Liver Disease (MELD) score—an objective score based on several laboratory values—was adopted in an attempt to allocate donor organs more equitably and based on medical urgency.
Mary T. Austin, M.D., M.P.H., and colleagues at the Vanderbilt University Medical Center, Nashville, Tenn., studied the outcomes associated with this change in policy by studying patients on the waiting list from March 1, 1999, to July 30, 2004—36 months before and 29 months after adoption of the MELD scoring system. Information about 60,392 individuals age 18 or older on the waiting list at any point during this period was obtained from the United Network for Organ Sharing data file.
The change in policy was associated with an immediate increase in number of deaths among individuals on the waiting list, from about 11 deaths to 13 deaths per 1,000 registrants per month. However, this was followed by a decline over time of about .09 deaths per 1,000 individuals per month.
"An immediate effect of decreased waiting time was also noted (from approximately 294 to 250 days; -44.4 days), which reached a new, lower post-intervention steady state," the authors write. "With the transition in allocation policy from a system that emphasized waiting time to one that favored disease severity with a de-emphasis on patient waiting time, many less-ill registrants placed on the list for the sole purpose of ‘banking time’ may have been removed, leading to an overall decrease in the time to transplantation for the remaining registrants."
The change did not appear to affect the number of new registrants per month or the survival rates three or six months after transplantation. "Given that the new allocation policy prioritizes patients with higher MELD scores to receive transplants, these results are encouraging," the authors write.
"In solid-organ transplantation, the liver transplantation community was the first to adopt an objective score as the basis of organ allocation policy," they continue. "Careful evaluation of this major change in the allocation of deceased donor livers is essential because it may direct future allocation policies. Using the interrupted time series method, our data provide more conclusive evidence that this policy had a positive impact on waiting list mortality. Because significant resources are expended in efforts to equitably allocate organs, this work provides empiric justification of this policy change."
(Arch Surg. 2007;142(11):1079-1085. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This work was supported in part by a Health Resources and Services Administration contract. 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, November 19, 2007
Media Advisory: To contact Erik Buskens, M.D., Ph.D., e-mail: e.buskens{at}epi.umcg.nl.
TONSILLECTOMY MAY INCREASE COSTS WITHOUT BENEFITS IN SOME CHILDREN
CHICAGO—A Dutch study suggests that among children with mild or moderate symptoms of throat infections, surgery to remove the tonsils may be more expensive but not necessarily more beneficial than watchful waiting, according to a report in the November issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Tonsillectomy—removal of the tonsils—with or without removal of the adenoids (tissue at the back of the throat) is one of the most frequently performed surgical procedures on children, according to background information in the article. However, the number of procedures performed varies widely by country. In 1998, adenotonsillectomies were performed on 115 per 10,000 children in the Netherlands, 65 per 10,000 British children and 50 per 10,000 American children. This suggests that different indications for surgery are used in each country.
Erik Buskens, M.D., Ph.D., of University Medical Center Utrecht, Utrecht, the Netherlands, and colleagues conducted a clinical trial involving 300 children age 2 to 8 who were recommended for adenotonsillectomy between 2000 and 2003. A group of 151 children were randomly assigned to have surgery within six weeks, while 149 were assigned to watchful waiting, which involved close monitoring and additional interventions as necessary. Parents kept diaries of all the children’s upper respiratory tract symptoms, measured their temperature daily and recorded any costs associated with their care. Follow-up visits occurred after three, six, 12, 18 and 24 months.
Throughout the study, annual costs among the watchful waiting group were about €551 or $500 (at the 2002 exchange rate) per year, while the group undergoing surgery had costs of €803 or about $730—a 46 percent increase. Children in the adenotonsillectomy group experienced fewer fevers and throat infections (.21 per child per year) and upper respiratory tract infections (.53 fewer per child per year). "The incremental costs per episode of fever, throat infection and respiratory tract infection avoided were €1,136 ($1,033), €1,187 ($1,079) and €465 ($423), respectively," the authors write.
"Overall, the balance between costs and effects in this population seemed unfavorable for adenotonsillectomy, with incremental cost-effectiveness ratios in excess of €465 ($423) per disease episode averted," they continue. "Note that this estimate includes societal costs such as parental leave of absence associated with their child’s illness. Had these costs been left out of the equation, the figures would be even somewhat less favorable. With time, the child’s immune system matures and the difference in adverse episodes disappears. Thus, the initial cost increment in the adenotonsillectomy group will never be counterbalanced by a continued positive health effect."
The authors note that in the Netherlands, a relatively inexpensive procedure is used to perform adenotonsillectomy; in countries using more costly procedures, the cost-effectiveness balance would be even less favorable. However, additional research may identify children in whom surgery is cost-effective.
(Arch Otolaryngol Head Neck Surg. 2007;133(11):1083-1088. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by a grant from the Dutch Health Care Insurance Board. 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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