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 SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 20, 2008)
RACE AND INSURANCE STATUS ASSOCIATED WITH DEATH FROM TRAUMA
STUDY EXAMINES ASSOCIATION BETWEEN BETA-BLOCKER USE AND RISKS OF DEATH AND HEART ATTACK AFTER SURGERY
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 20, 2008)
LIGHT-ACTIVATED THERAPY MAY CHANGE SKIN AT MOLECULAR LEVEL
STUDY COMPARES SAFETY AND EFFECTIVENESS OF LASER THERAPIES FOR HAIR REMOVAL
STUDY COMPARES RESULTS OF ALLERGY PATCH TESTS BETWEEN CHILDREN AND ADULTS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, October 20, 2008)
CHEST SCANS MAY HELP MONITOR SPREAD OF HEAD AND NECK CANCER IN HIGH-RISK PATIENTS
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, October 20, 2008
Media Advisory: To contact Adil H. Haider, M.D., M.P.H., call Eric A. Vohr at 410-955-8665.
RACE AND INSURANCE STATUS ASSOCIATED WITH DEATH FROM TRAUMA
CHICAGO—African American and Hispanic patients are more likely to die following trauma than white patients, and uninsured patients have a higher death risk when compared with those who have health insurance, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
Health disparities based on race, income and insurance status have previously been documented in patients with cancer and those undergoing surgery, among other treatments and conditions, according to background information in the article.
Adil H. Haider, M.D., M.P.H., of the Johns Hopkins School of Medicine, Baltimore, and colleagues reviewed data from the National Trauma Data Bank for 429,751 patients age 18 to 64 years treated at approximately 700 trauma centers nationwide between 2001 and 2005. Of these, 72,249 were African American, 41,770 were Hispanic and 262,878 were white; 47 percent had health insurance.
Overall, death rates were higher among African American (8.2 percent) and Hispanic (9.1 percent) patients than among white patients (5.7 percent). Uninsured patients were also more likely to die than insured patients (8.6 percent vs. 4.4 percent). "Mortality rates were substantially higher for all uninsured patients, almost doubling for African American (4.9 percent to 11.4 percent) and Hispanic patients (6.3 percent to 11.3 percent) compared with white patients (4.2 percent to 7.9 percent)," the authors write. "The absence of health insurance increased a trauma patient's adjusted odds of death by almost 50 percent."
Patients in minority groups were much more likely to be uninsured than white patients—about one-third of white patients, two-thirds of African American patients and two-thirds of Hispanic patients lacked insurance. Lack of insurance is associated with poorer baseline health status; because pre-existing conditions are known to affect trauma outcomes, this could partially account for the higher death rates in the uninsured, the authors note.
However, insurance status alone could not explain all racial disparities in trauma death rates. "Of the insured patients, both Hispanic and African American patients had significantly higher odds of mortality compared with white patients," the authors note. Other issues that may contribute to racial differences include mistrust, subconscious bias and stereotyping, but further study is needed to explore these possibilities, they continue.
"Understanding insurance and race-dependent differences is a crucial first step toward ameliorating health care disparities," the authors conclude. "The next step will be to comprehend the underlying reasons for these differences, which will enable the development of interventions to close the gap between patients of different races and payer statuses."
(Arch Surg. 2008;143[10]:945-949. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by the Johns Hopkins School of Medicine Department of Surgery New Faculty Academic Support Group. 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, October 20, 2008
Media Advisory: To contact corresponding author Kamal M. F. Itani, M.D., call Diane Keefe at 857-203-5879.
STUDY EXAMINES ASSOCIATION BETWEEN BETA-BLOCKER USE AND RISKS OF DEATH AND HEART ATTACK AFTER SURGERY
CHICAGO—Some patients who received beta-blockers before and around the time of undergoing non-cardiac surgery appear to have higher rates of heart attack and death within 30 days of their surgery, according to a report in the October issue of Archives of Surgery, one of the JAMA/Archives journals.
Non-cardiac surgery carries a risk of death, stroke or heart attack in patients who have or are at risk for heart disease, according to background information in the article. "Prevention of these perioperative [around the time of surgery] cardiac complications continues to be the goal of intense research and investigations," the authors write. Following observations of an increase in heart rate before such events and clinical reports of fewer complications in patients taking beta-blockers for hypertension, researchers began investigating whether these medications should be given to patients undergoing surgery.
Haytham M. A. Kaafarani, M.D., of the Veterans Affairs Boston Health Care System, Boston University and Harvard Medical School, Boston, and colleagues examined 1,238 patients who underwent non-cardiac surgery—including plastic, vascular, abdominal or hernia repair surgery—at one medical center in 2000. Before their procedures, the patients were classified as high, intermediate, low or negligible cardiac risk, and each procedure was also classified as high-, intermediate- or low-risk. A total of 238 patients received beta-blockers perioperatively and were matched by age, sex, cardiac risk, procedure risk, smoking status and kidney health to 408 patients who also underwent surgery at the same center but did not receive beta-blockers.
"Patients at all levels of cardiac risk who received beta-blockers had lower preoperative and intraoperative heart rates," the authors write. Over the 30 days after surgery, the beta-blocker group had higher rates of heart attack (2.94 percent vs. 0.74 percent) and death (2.52 percent vs. 0.25 percent) than those in the control group.
None of the deaths occurred among patients classified as high cardiac risk. However, those in the beta-blocker group who died had significantly higher heart rates before surgery than those who didn't (86 beats per minute vs. 70 beats per minute). "As subtle as it may be, this finding suggests that a low target preoperative rather than intraoperative heart rate is essential for the protective effect of beta-blockers," the authors write. "The relationship between preoperative (rather than intraoperative or postoperative) heart rate and perioperative mortality stresses the importance of not only initiating but also titrating the effect of beta-blockers to an acceptable target heart rate before surgery."
"In summary, our study adds to the controversy regarding the optimal use of perioperative beta-blockers in patient populations at various levels of cardiac risk," the authors write. "Further investigations in this field with standardizing of beta-blockade regimen and with monitoring of heart rate in populations at various levels of cardiac risk should be pursued."
(Arch Surg. 2008;143[10]:940-944. 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, October 20, 2008
Media Advisory: To contact Jeffrey S. Orringer, M.D., call Katie Vloet at 734-764-2220.
LIGHT-ACTIVATED THERAPY MAY CHANGE SKIN AT MOLECULAR LEVEL
CHICAGO— Photodynamic therapy—which involves a light-activated medication and exposure to a light source—appears to produce changes at the molecular level in aging skin, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals. These changes are consistent with increased collagen production and improved appearance of the skin.
"The deleterious effects of exposure of the skin to UV irradiation are well established," the authors write as background information in the article. "Alternatively, several visible and infrared lasers and light sources have been reported to produce various positive changes in the clinical and histologic [microscopic] appearance of the skin. In recent years, the concept of employing a photosensitizing compound to enhance the effects of some light-based therapies has been espoused."
For aesthetic treatments, this type of photodynamic therapy typically involves application of a topical medication, such as 5-aminolevulinic acid (5-ALA), that is activated by exposure to light. Jeffrey S. Orringer, M.D., and colleagues at the University of Michigan Medical School, Ann Arbor, studied this treatment in 25 adults age 54 to 83 with sun-damaged skin on their forearms. Before treatment, the degree of skin damage was rated and a biopsy (tissue sample) was taken from the forearm. A solution containing 5-ALA was applied to the treatment site and left on for three hours; the skin was then washed with cleanser and treated with a pulsed-dye laser. Participants returned for re-examination and to provide additional biopsy samples four to five times during the six months following treatment.
After photodynamic therapy, tissue samples demonstrated a five-fold increase in levels of Ki67, a protein thought to play a fundamental role in the growth and development of new skin cells. The epidermis (skin's outer layer) increased in thickness 1.4-fold. Levels of enzymes and other compounds associated with the production of collagen, the main structural protein in the skin, also were increased.
"Photodynamic therapy with the specific treatment regimen employed produces statistically significant quantitative cutaneous molecular changes (e.g., production of types I and III collagen) that are associated with improved appearance of the skin," the authors conclude. When compared with previous data regarding the effectiveness of pulsed-dye laser therapy alone, these results suggest that using a photosensitive compound such as 5-ALA enhances changes in the skin.
"Although our molecular measurements cannot yet precisely predict clinical outcomes for a single given patient, taken together they are very much in keeping with the bulk of the clinical literature and thus lend substantial support to the conclusions reached by other researchers who have published purely clinically oriented work in this field," the authors conclude. "We believe that the quantitative amount of dermal repair and regeneration induced by a specific therapeutic intervention very likely underlies the degree of clinical rejuvenation produced. Thus, it is our hope that, with further development, our working molecular model may one day be used to predict the clinical value of new technologies in aesthetic dermatology."
(Arch Dermatol. 2008;144[10]:1296-1302. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was funded in its entirety by the Human Appearance Research Program (HARP) of the Department of Dermatology, University of Michigan. 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, October 20, 2008
Media Advisory: To contact corresponding author Alireza Firooz, M.D., email firozali{at}sina.tums.ac.ir.
STUDY COMPARES SAFETY AND EFFECTIVENESS OF LASER THERAPIES FOR HAIR REMOVAL
CHICAGO—Laser therapies commonly used for removal of unwanted hair appear to be safer and remove leg hair more effectively when used separately than when used as a combination treatment, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Unwanted hair that potentially has profound effects on psychological well-being is an exceedingly common concern for men and women," according to background information in the article. During the past decade, laser hair removal has become a popular and accepted method used to reduce the growth of unwanted hair. "Laser-assisted photoepilation or laser hair removal, as first reported in 1996, is accomplished through destruction of the follicular unit [the hair follicle]."
Seyyed Masoud Davoudi, M.D., of the Baqiyatallah University of Medical Sciences, Tehran, Iran, and colleagues analyzed the results of using long-pulsed 755-nanometer alexandrite lasers (12-millimeter and 18-millimeter spot sizes) individually, using a long-pulsed 1,064-nanometer Nd:YAG laser (12-millimeter spot size) and using a combination of the Nd:YAG and alexandrite 12-millimeter spot lasers to reduce leg hair growth on four areas of the legs of 20 individuals (average age 32.6). Participants underwent treatment at a private laser skin center and received a total of four treatment sessions at eight-week intervals, and 15 patients completed the study. Average hair density was measured with a hair counting device and special software (Visionmed AG) and hair reduction was assessed through digital photographs before treatment and at eight- and 18-month follow up sessions. Adverse effects following treatment were also noted.
The average hair reductions 18 months after final treatment were 75.9 percent for the 12-millimeter spot size alexandrite laser, 84.3 percent for the 18-millimeter spot size alexandrite laser, 73.6 percent for the Nd:YAG laser and 77.8 percent for the combination therapy.
Average pain severity was higher in areas that received the alexandrite laser treatments than in those treated with the Nd:YAG laser. Additionally, the highest incidence of pain was reported in areas that received the combination treatment. Areas with combination treatment were also more likely to experience hyperpigmentation (dark spots on the skin), with four participants experiencing this complication until the last follow-up session.
"Despite other studies showing more efficacy of the alexandrite rather than the Nd:YAG laser, our trial results showed no significant difference between them," the authors conclude. "The use of alexandrite or Nd:YAG laser systems alone for at least four treatments sessions and with eight-week intervals have long-term persistent efficacy in hair reduction with acceptable and transient adverse effects."
(Arch Dermatol. 2008;144[10]:1323-1327. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This was supported by a research grant from the Undersecretary of Research, Tehran University of Medical Sciences. 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, October 20, 2008
Media Advisory: To contact Kathryn A. Zug, M.D., call Jason Aldous at 603-653-1913.
STUDY COMPARES RESULTS OF ALLERGY PATCH TESTS BETWEEN CHILDREN AND ADULTS
CHICAGO—Adults and children who are referred for patch testing of allergens appear equally likely to have allergic contact dermatitis, although they tend to react to different allergens, according to a report in the October issue of Archives of Dermatology, one of the JAMA/Archives journals.
Skin reactions to allergens are common among children, according to background information in the article. They can occur both on areas of the skin that come in direct contact with an allergen (contact dermatitis) and on areas that aren't directly affected (atopic dermatitis). Children suspected of contact dermatitis are often referred for patch testing, in which skin is exposed to various allergens affixed to a plaster tape to identify which cause a reaction.
Kathryn A. Zug, M.D., of Dartmouth-Hitchcock Medical Center, Lebanon, N.H., and colleagues analyzed results from 391 children age 18 and younger who underwent patch testing between 2001 and 2004. They compared results of the pediatric population to a group of 9,670 adults (age 19 and older) who were tested during the same time period.
Children and adults tested positive for at least one allergen at approximately the same rate (51.2 percent for children vs. 54.1 percent for adults). "Our study showed significant differences between the frequency of individual positive reactions to allergen patch tests in children and adults; children were more likely to have reactions to nickel, cobalt, thimerosal and lanolin, whereas adults were more likely to have positive reactions to neomycin, fragrance mix, M. pereirae (balsam of Peru [an extract from the balsam tree used as an alternative therapy]) and quaternium 15," the authors write.
The common positive reactions in children are expected given probable exposure patterns among this population. Some children reacted to supplemental allergens not included in common patch test series (15 percent) or in commercially available tests (39 percent). Children with a positive reaction were more likely to have atopic dermatitis included as one of their final diagnoses than were adults (34 percent vs. 11.2 percent).
"Patch testing in children suspected of having allergic contact dermatitis is a valuable endeavor. Despite their limited back size, an expanded allergen series helps to identify important positive relevant allergens. Allergen concentration does not need modification for testing in children," the authors conclude. "The top 45 allergens with the most frequent positive and relevant reactions reported in this study should serve as a guide to patch testing in children suspected of having allergic contact dermatitis in North America. Including supplemental allergens to the patch test materials based on clinical suspicion is also useful in some patients."
(Arch Dermatol. 2008;144[10]:1329-1336. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This study was supported by an American Contact Dermatitis Society Clinical Research Award the Nethercott Award for the study of epidemiology of contact dermatitis. 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, October 20, 2008
Media Advisory: To contact corresponding author Shyh-Kuan Tai, M.D., e-mail sktai{at}vghtpe.gov.tw.
CHEST SCANS MAY HELP MONITOR SPREAD OF HEAD AND NECK CANCER IN HIGH-RISK PATIENTS
CHICAGO—Among high-risk patients with head and neck cancer, chest computed tomography (CT) may help detect disease progression involving the lungs, according to a report in the October issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Developing a second, distant cancer (a metastasis or a new primary cancer) is an important factor affecting survival of patients with head and neck squamous cell carcinoma, which accounts for most head and neck cancers, according to background information in the article. The most common site at which such patients develop new metastases is the lungs, with an incidence of 8 percent to 15 percent. Chest X-rays are the most commonly used screening tool for detecting these malignancies but do not always identify early abnormalities.
Yen-Bin Hsu, M.D., of Taipei Veterans General Hospital, Taiwan, and colleagues evaluated 270 screening chest CT scans performed over 42 months in 192 patients with head and neck squamous cell carcinoma. The scans were categorized as new cases, follow-up cases or recurrent cases, and results classified as normal or abnormal.
Of the 270 scans, 79 (29.3 percent) were considered abnormal, including 54 (20 percent) that identified a malignant neoplasm of the lung and 25 (9.3 percent) showing indeterminate abnormalities. "The rate of an abnormal scan was significantly higher in the follow-up case group (44.2 percent) than in the new case group (14.2 percent)," the authors write. Patients whose cancer was classified as stage N2 or N3 (indicating some degree of lymph node involvement), who had stage IV disease (in which the cancer has spread to another organ), who had recurrent disease or who had a distant metastasis in another site were more likely to have a malignant neoplasm of the lung.
"Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them," the authors write. "Based on the progressive changes in follow-up scans, 44 percent of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small (less than 1 centimeter) solitary nodules, which were usually resectable [operable], carried significantly higher chances (66.7 percent) of being a malignant neoplasm."
"For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan," they continue. "In conclusion, chest CT is recommended for high-risk patients, especially every six months for the first two years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma. High-risk patients include those with N2 or N3 disease, stage IV disease or locoregional recurrence. For patients with indeterminate small (less than 1 centimeter) solitary pulmonary nodules, aggressive evaluation and management are imperative because of the high rate of a malignant neoplasm of the lung."
(Arch Otolaryngol Head Neck Surg. 2008;134[10]:1050-1054. 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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