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 17, 2008)
INDIGO OINTMENT MAY HELP TREAT PATIENTS WITH PSORIASIS
STUDY HELPS IDENTIFY BEACHGOERS AT INCREASED RISK OF SKIN CANCER
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 17, 2008)
MMEDIATE BREAST RECONSTRUCTION MORE COMMON AMONG RESIDENTS OF WEALTHIER, BETTER-EDUCATED COMMUNITIES
STUDY INVESTIGATES ETHNIC DISPARITIES IN TREATMENT OF TRAUMA PATIENTS
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 17, 2008)
TIME, SURGERY APPEAR TO REDUCE EPISODES OF DIZZINESS IN PATIENTS WITH MÉNIÈRE'S DISEASE
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, November 17, 2008)
ARCHIVES OF FACIAL PLASTIC SURGERY CELEBRATES 10 YEARS OF PUBLICATION
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, November 17, 2008
Media Advisory: To contact corresponding author Jong-Hwei Su Pang, Ph.D.,
e-mail jonghwei{at}mail.cgu.edu.tw.
INDIGO OINTMENT MAY HELP TREAT PATIENTS WITH PSORIASIS
CHICAGO—An ointment made from indigo naturalis, a dark blue plant-based powder used in traditional Chinese medicine, appears effective in treating plaque-type psoriasis, according to a report in the November issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis is a chronic skin disease for which no cure exists, only therapies that bring it into remission, according to background information in the article. "Traditional Chinese medicine is one of the most frequently chosen alternative therapies in China and Taiwan, and psoriasis has been treated for centuries with topical and oral herbal preparations," the authors write. "Indigo naturalis is one of the Chinese herbal remedies that has been reported to exhibit potential antipsoriatic efficacy. However, long-term systemic use has been occasionally associated with irritation of the gastrointestinal tract and adverse hepatic [liver] effects."
Yin-Ku Lin, M.D., of Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, and colleagues conducted a randomized trial of an ointment containing indigo naturalis in 42 patients with treatment-resistant psoriasis. Participants enrolled in the study between May 2004 and April 2005 and applied the indigo naturalis ointment to a psoriatic plaque on one side of their body (usually on the arm, elbow, leg or knee) and then a non-medicated ointment to a parallel plaque on the other side of their body. The researchers assessed and photographed patients' skin plaques at the beginning of the study and again after two, four, six, eight, 10 and 12 weeks.
After 12 weeks of treatment, the plaques treated with indigo naturalis ointment showed significant improvement in scaling, erythema (redness) and induration (hardening) when compared with the plaques treated with non-medicated ointment. "Weighting the sum of scaling, erythema and induration scores by the lesion area and comparing between the start and end of the study, the indigo naturalis ointment-treated lesions showed an 81 percent improvement, whereas the vehicle [non-medicated] ointment-treated lesions showed a 26 percent improvement," the authors write.
Of the 34 patients who completed the study, none experienced worsening psoriasis in the areas treated with indigo naturalis, while the treated plaques were completely or nearly completely cleared for 25 of them (74 percent). None experienced serious adverse effects. Four patients reported itching after applying the indigo naturalis ointment, but only for a couple of days at the start of treatment.
"In conclusion, we present a randomized controlled trial showing the use of topical indigo naturalis ointment for the treatment of chronic plaque psoriasis to be both safe and effective," the authors write. "Future research for a more potent extraction from this crude herb that can provide better absorption and convenience would help improve patient compliance with the treatment regimen. However, much more research will be necessary to clarify the pharmacology of indigo naturalis."
(Arch Dermatol. 2008;144[11]:1457-1464. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from Chang Gung Memorial Hospital. 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 17, 2008
Media Advisory: To contact David L. O'Riordan, Ph.D., email d.oriordan@qut.edu.au. To contact editorial co-author Sherry L. Pagoto, Ph.D., call 508-856-2000.
STUDY HELPS IDENTIFY BEACHGOERS AT INCREASED RISK OF SKIN CANCER
CHICAGO—Identifying the sun-protection practices and risk profiles of beachgoers may help determine those who would benefit from targeted interventions intended to reduce the risk of skin cancer, according to a study in the November issue of Archives of Dermatology, one of the JAMA/Archives journals.
In the U.S., skin cancer incidence and death attributable to outdoor exposure to UV radiation (UVR) has increased rapidly in the past three decades, according to background information in the article. Recommendations to reduce the risk of skin cancer include limiting time spent in the sun, using sunscreen and wearing protective clothing. "Adults and adolescents are particularly at risk for intense, episodic sun exposure while on vacation or in 'high-risk' environments such as beaches," the authors write.
David L. O'Riordan, Ph.D., of the University of Queensland, Brisbane, Australia, and colleagues conducted a study examining the levels of UVR exposure and the range of sun protection behaviors of vacationers at a popular beach in Honolulu, Hawaii. The study, conducted in February and March 2004, included 88 participants who completed a sun habits survey prior to entry to the beach and an exit survey on leaving regarding their sun protection practices while at the beach. UVR was measured daily.
The researchers found that the participants spent an average of three hours at the beach, during which most were exposed to levels of UVR equivalent to five times the UVR dose required to result in sunburn among unprotected fair-skinned populations. Approximately 70 percent of the participants went to the beach with an intention to tan, despite 40 percent reporting they had obtained a sunburn in the previous 48 hours. Almost 23 percent of participants reported attending a tanning salon in the past 30 days.
Analysis identified three groups with distinct characteristics and sun protection behaviors:
- Class 1—Unconcerned and at lower risk, who used the least amount of sunscreen and less clothing, used shade the least, intended to tan, and had the fewest members with a high risk of developing skin cancer.
- Class 2—Tan seekers, highest number who reported that they sunburn easily, used the most sunscreen coverage and the least clothing coverage, had the most tanning salon use.
- Class 3—Were concerned about UVR and were protected, the most careful group with the most clothing coverage and shade use and had the lowest proportion with an intention to tan.
"Findings from this study indicate that the beach is an ideal setting to initiate a program aimed at promoting sun-safe practices while enjoying the many activities that a day at the beach has to offer. Collaborative efforts with key stakeholders such as local government, the tourist industry, local business and community representatives should examine a broad range of strategies—not just targeting individual behavior change, but also the environment—to promote the reduction of intense UVR exposures among beachgoers," the authors write.
"Specific strategies should target the subsets of the beach-going population (particularly those in group 2—the tan seekers) that intend to tan and sunburn repeatedly, taking into account their relevant personal attributes and behavior patterns. A balance should be provided between messages that focus on the immediate detrimental effects (photoaging, soreness) as well as the long-term detrimental health effects (skin cancer) of excessive UVR exposure, all the time balancing the health interests of the public with the needs of local industry."
(Arch Dermatol. 2008;144[11]:1449-1455. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by Friends of the Cancer Research Center of Hawaii. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: NOT ALL TANNERS ARE CREATED EQUAL
The identification of tanning subtypes should eventually improve the ability to determine appropriate health interventions, writes Sherry L. Pagoto, Ph.D., and Joel Hillhouse, Ph.D., of the University of Massachusetts Medical School, Worcester, Mass., in an accompanying editorial.
"The advantages of the development of a tanning typology will not be fully realized until brief assessments that can accurately classify patients are developed and empirically verified. We believe that the latent class analysis used by O'Riordan et al to identify and define their subtypes is an important step in this process. Such assessments, together with messages tailored to each subtype, will give clinicians a way to identify those patients in greatest need as well as the most effective messages to deliver to specific patients. Given the time constraints of the typical patient-clinician interaction, such systems may very well maximize the efficiency of delivering UV safety information. Public health skin cancer prevention programs may also benefit from the improved accuracy of risk identification as well as the ability to tailor messages to various tanning subtypes, perhaps using interactive online intervention programs."
(Arch Dermatol. 2008;144[11]:1505-1508. 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.
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 17, 2008
Media Advisory: To contact Gedge D. Rosson, M.D., contact Eric A. Vohr at 410-955-8665 or evohr1@jhmi.edu.
IMMEDIATE BREAST RECONSTRUCTION MORE COMMON AMONG RESIDENTS OF WEALTHIER, BETTER-EDUCATED COMMUNITIES
CHICAGO—Patients appear more likely to have immediate breast reconstruction after mastectomy if they live in communities with higher household incomes, lower population density and more individuals who have gone to college, according to a report in the November issue of Archives of Surgery, one of the JAMA/Archives journals.
Breast cancer affects 134 of every 100,000 women each year in the United States, according to background information in the article. Many women consequently undergo mastectomy, or surgical removal of the breast. If women choose to have reconstructive breast surgery, they can do it at the same time or after a delay. "Immediate reconstruction has been shown to be superior to delayed reconstruction for overall aesthetics, psychosocial well-being and cost-effectiveness," the authors write. "With these established benefits of immediate breast reconstruction, we hypothesized that we could use immediate reconstruction as a surrogate for optimal therapy and access to care for patients undergoing mastectomy."
Gedge D. Rosson, M.D., and colleagues at the Johns Hopkins University School of Medicine, Baltimore, analyzed data from 18,690 patients (average age 60.1) who underwent mastectomy in Maryland between 1995 and 2004. Community demographics were obtained from a commercially available software program.
The researchers focused their analysis on 17,925 patients who were white or African-American. Of these, 4,994 (27.9 percent) underwent breast reconstruction during the same hospitalization as their mastectomy. "We found that increasing income and increasing population density of the city in which the patient lives had statistically significant positive associations with the likelihood of immediate breast reconstruction," the authors write. "African American race/ethnicity, older age, increasing percentage of the patient's neighborhood with a high school education or less and increasing African American composition of the patient's neighborhood had statistically significant negative associations."
On an individual level, African Americans were 47 percent less likely to receive immediate reconstruction, and the likelihood decreased with increasing age. However, community factors were still associated with access to immediate reconstruction, independent of patient characteristics.
"In clinical medicine, we normally treat individuals, but this multilevel database analysis points to the need also to evaluate the community in which the patient lives," the authors conclude. "The racial/ethnic mix, mean [average] income and education level of the neighborhood and community are associated with breast cancer management outcomes. Prospective public health measures, including educational and informative programs, can be developed and implemented in the community to address these inequalities (particularly racial/ethnic disparities based on neighborhood) and to increase the likelihood that patients with breast cancer and mastectomy obtain immediate reconstruction."
(Arch Surg. 2008;143[11]:1076-1081. 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 17, 2008
Media Advisory: To contact Shahid Shafi, M.D., M.P.H., call Connie Piloto at 214-648-3404.
STUDY INVESTIGATES ETHNIC DISPARITIES IN TREATMENT OF TRAUMA PATIENTS
CHICAGO—The initial evaluation and management of injured patients from minority ethnic groups nationwide appears to be similar to that of non-Hispanic white patients, according to a report in the November issue of Archives of Surgery, one of the JAMA/Archives journals.
"Ethnic disparities in our health care system have been well documented in treatment of several diseases, such as coronary artery disease, congestive heart failure, renal failure, acute appendicitis and organ transplant," according to background information in the article. "These disparities range from limited access to health care to lower use of evidence-based therapies and a lower rate of invasive procedures."
Shahid Shafi, M.D., M.P.H., and Larry M. Gentilello, M.D., of the University of Texas Southwestern Medical School, Dallas, analyzed data obtained from 8,563 trauma patients in a 2003 national survey to determine if there were differences in the initial assessment and management of injuries based on patient ethnicity. Patients were divided into three groups: non-Hispanic white (n=6,106), African American (n=1,406) and Hispanic (n=1,051). Researchers noted patients' age, sex, insurance status, injury and measures of injury severity.
Minority patients were more likely to be younger, less likely to be insured and more likely to have been treated at a public hospital but were similar in sex, method of injury and injury severity when compared with non-Hispanic white patients.
There were no significant differences between non-Hispanic white patients and African American and Hispanic patients in intensity of emergency department assessment, monitoring, treatment or release from the emergency department. There were also no considerable differences by region, hospital ownership or patient insurance status.
"The obvious implication of the lack of ethnic disparities in emergency department management is that other causes of ethnic disparities in functional outcomes of trauma patients should be sought. These may include quality of inpatient care, use of high-cost medications and procedures, access to acute and long-term rehabilitation services and follow-up after discharge from acute care hospitalization," the authors conclude. "It is also entirely possible that the disparities in outcomes have little to do with quality of medical care received."
"Other factors, such as the socioeconomic status, educational level, employment and insurance status, rural vs. urban location, language barriers and cultural and religious beliefs and practices, need to be studied further to understand differences between various ethnic groups."
(Arch Surg. 2008;143[11]:1057-1061. 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 17, 2008
Media Advisory: To contact Herminio Perez-Garrigues, M.D., Ph.D., e-mail perez_her@gva.es. To contact Stephen J. Wetmore, M.D., call Amy Johns at 304-293-1412.
TIME, SURGERY APPEAR TO REDUCE EPISODES OF DIZZINESS IN PATIENTS WITH MÉNIÈRE'S DISEASE
CHICAGO—Episodes of dizziness tend to become less frequent over time in patients with Ménière's disease, a condition characterized by vertigo, hearing loss and ringing in the ears, according to a report in the November issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. A second report finds that a surgical procedure to drain fluid from the inner ear appears to reduce vertigo in three-fourths of patients with the condition.
Several studies have outlined how hearing loss and tinnitus (ringing in the ears) progress over time in patients with Ménière's disease, according to background information in the article. "Hearing loss increases during follow-up until it reaches a moderate or severe level, and, similarly, tinnitus becomes constant, causing a decrease in the health-related quality of life in many individuals," the authors write. "However, the time course of episodes of vertigo [dizziness] is less clear, even though the primary goal of treatment is to decrease the frequency and duration of these episodes."
Herminio Perez-Garrigues, M.D., Ph.D., of Hospital Universitario La Fe, Valencia, Spain, and colleagues studied 510 individuals from eight hospitals who met criteria for definitive Ménière's disease between 1999 and 2006. The patients were given conservative care and followed through 2006 to evaluate the frequency and duration of vertigo through the course of the disease.
"Ménière's disease affects both sexes and both ears equally, with onset generally in the fourth decade of life," the authors write. "The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than six hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease."
The percentage of patients with no episodes of vertigo increases as the disease progresses, and 70 percent of patients who did not have vertigo during any one year also did not have any episodes in the following year. "In contrast, the likelihood that patients who had episodes of vertigo continued to have them was slightly greater than 50 percent," the authors write.
"This may mean that the activity of the etiologic factor causing the episodes persists for a few months and then ceases to be active," they continue. "However, the problem remains latent until this or another factor again alters inner-ear function. Logically, the evolution of Ménière's disease depends on certain unknown variables such as etiology and personal characteristics. After analyzing our results, we believe it would be interesting to study whether patients can be classified into groups with the same evolutionary process and to investigate the variable or variables that might define such groups."
In another study, Stephen J. Wetmore, M.D., of West Virginia School of Medicine, Morgantown, reports on the results of endolymphatic sac surgery for patients with Ménière's disease who did not respond to more conservative therapies, such as low-sodium diets or diuretic medications. The surgery involves inserting a shunt into the endolymphatic sac in the inner ear and draining the fluid inside to relieve symptoms. Between 1989 and 2006, 51 patients underwent this surgery for the first time and 16 underwent revision surgery for recurring disease.
After 24 months, the surgery improved major spells of vertigo in 77 percent of patients undergoing the procedure for the first time and 65 percent of patients undergoing revision surgery. For those having revision surgery, results appeared better in patients who developed recurrent symptoms more than two years after than procedure than among those who failed treatment earlier.
"Endolymphatic sac surgery seems to be beneficial in regard to decreasing or eliminating major dizzy spells in those patients who continue to have frequent and severe dizzy spells despite maximal medical therapy," Dr. Wetmore concludes. "For those patients who initially do well after sac surgery but who experience recurrence of symptoms later, revision surgery is often beneficial. The longer the interval between primary endolymphatic sac surgery and the revision procedure, the more likely it is that the patient will obtain a beneficial response from the revision surgery."
(Arch Otolaryngol Head Neck Surg. 2008;134[11]:1149-1154, 1144-1148. 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 17, 2008
Media Advisory: For more information, contact JAMA/Archives Media Relations at 312-464-5262 or
e-mail mediarelations{at}jama-archives.org.
ARCHIVES OF FACIAL PLASTIC SURGERY CELEBRATES 10 YEARS OF PUBLICATION
CHICAGO—The November/December 2008 issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals, celebrates the 10-year anniversary of the journal's publication and features a special series of articles on the art and science of the specialty.
The field is a dynamic one, notes journal editor Wayne F. Larrabee Jr., M.D., Seattle, in an introductory editorial. "On the research frontier, advances in wound healing, laser technology, biomaterials and other areas will transform facial plastic surgery in ways we can only imagine," he writes. "Surgical techniques will advance in an exciting—but more predictable—manner and result in better, safer outcomes for our patients. The articles in this issue speak strongly about the present and future of both facial plastic surgery and the Archives."
Other topics covered in the issue include:
- Advances in craniofacial surgery
- Facial reanimation
- Training of facial plastic and reconstructive surgeons
- Preventing disability and death through surgical intervention
"In the next decade, we must preserve the passion for medicine that defines our specialty," Dr. Larrabee concludes. "Our dedicated researchers and clinicians will surely develop new science and technology to improve quality and safety for our patients. The editorial board and staff of the Archives look forward to publishing this research in new and imaginative ways for decades to come."
(Arch Facial Plast Surg. 2008;10[6]:369. 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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