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 OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 15, 2008)
BREATHING PROBLEMS DURING SLEEP ASSOCIATED WITH CALORIES BURNED AT REST
ALLERGIES ALONE NOT ASSOCIATED WITH INCREASED RISK OF NIGHTTIME BREATHING PROBLEMS
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 15, 2008)
HIGHER LEVELS OF OBESITY-RELATED HORMONE FOUND IN PATIENTS WITH PSORIASIS
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, December 15, 2008)
CERTAIN FACTORS ASSOCIATED WITH ATTRITION DURING GRADUATE MEDICAL EDUCATION TRAINING
STUDY EXAMINES ASSOCIATION OF RACE AND INSURANCE STATUS WITH PRESENTATION AND SURGICAL TREATMENT OF DIVERTICULITIS
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, December 15, 2008
Media Advisory: To contact Eric J. Kezirian, M.D., M.P.H., call Kirsten Michener at 415-476-2557.
BREATHING PROBLEMS DURING SLEEP ASSOCIATED WITH CALORIES BURNED AT REST
CHICAGO—Individuals with sleep-related breathing disorders appear to burn more calories when resting as their conditions become more severe, according to a report in the December issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Sleep-related breathing disorders include snoring, pauses in breathing (sleep apnea) and other conditions in which airways are partially or completely obstructed during sleep. "Obesity is a major risk factor for the development of sleep-disordered breathing, and changes in body weight are associated with changes in sleep-disordered breathing severity," the authors write as background information in the article. "It is unclear whether weight gain is simply a cause of sleep-disordered breathing or whether sleep-disordered breathing may be associated with alterations in energy metabolism that, in turn, lead to weight gain and complicate the treatment of these two disorders that often coexist."
Body weight is based on the balance between energy or calorie intake and expenditure, the authors note. Resting energy expenditure, or the number of calories burned while resting, is one component of total daily energy expenditure. Eric J. Kezirian, M.D., M.P.H., of the University of California, San Francisco, and colleagues assessed the resting energy expenditure in 212 adults with signs or symptoms of sleep-related breathing disorders. Participants’ medical history was taken, and they underwent a physical examination, sleep monitoring through polysomnography and determination of resting energy expenditure using a device known as an indirect calorimeter. The calorimeter measures oxygen consumption and carbon dioxide production, which can be used to determine resting energy expenditure in calories per day.
Among the 212 participants, the average resting energy expenditure was 1,763 calories per day. Several measures of sleep-disordered breathing severity were associated with increases in resting energy expenditure. For example, those who scored the highest on a scale of apnea and hypopnea (disruptions in breathing) had a resting energy expenditure of 1,999, while those who scored the lowest expended an average of 1,626 calories per day resting.
Resting energy expenditure may be affected by responses of the nervous system that occur during sleep-related breathing disorders and has been previously shown to increase when sleep has been disrupted.
"This study advances our knowledge concerning sleep-disordered breathing and metabolic rates, but it does not define the connection between sleep-disordered breathing and body weight," the authors write. "Body weight is determined by the balance between energy intake and expenditure. Although the findings of this study suggest that sleep-disordered breathing increases energy expenditure, it ignored two important aspects of this balance."
"First, sleep-disordered breathing often results in fatigue and other decrements in daytime functioning that can limit physical activity. Second, this work does not specifically incorporate the emerging evidence that suggests that sleep-disordered breathing may alter energy intake, whether through hormonal or other mechanisms. Future research considering the effect of sleep-disordered breathing on body weight can include the effects on energy intake and expenditure."
(Arch Otolaryngol Head Neck Surg. 2008;134[12]:1270-1275. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a grant from the National Center for Research Resources, a component of the National Institutes of Health. The study was conducted in cooperation with Stanford University Sleep and Research Center and was supported in part by the registered public non-profit Sleep Education and Research Foundation, Palo Alto. 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, December 15, 2008
Media Advisory: To contact corresponding author Hideaki Suzuki, M.D., Ph.D., e-mail: suzuhyde{at}med.uoeh-u.ac.jp.
ALLERGIES ALONE NOT ASSOCIATED WITH INCREASED RISK OF NIGHTTIME BREATHING PROBLEMS
CHICAGO—Allergic rhinitis does not appear to be associated with snoring or daytime sleepiness, but individuals with obstructed nasal passages are likely to experience both regardless of whether they have allergies, according to a report in the December issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Nasal obstruction is one of the most troublesome symptoms of nasal and sinus diseases, including allergic rhinitis, according to background information in the article. "People with nasal obstruction often experience other symptoms, including headache, thirst, lack of concentration, daytime cognitive deficits, daytime sleepiness and disturbed sleep, which impair their daily and social activities," the authors write. "There has been growing awareness that the morbidity [illness] of allergic rhinitis in the general population is increasing and is leading to a decline in school and work performance, resulting not only in a medical economic loss but also in a large social economic loss."
To investigate the relationships among nasal obstruction, snoring and excessive daytime sleepiness in people with and without allergies, Nobuaki Hiraki, M.D., and colleagues at the University of Occupational and Environmental Health, Kitakyushu, Japan, analyzed responses to a survey of Japanese workers. Of the 1,878 workers asked to complete questionnaires, 1,615 responded (86 percent) and 1,459 provided sufficient information for the analysis.
Participants were divided into four groups: those with allergies and nasal obstruction, those with nasal obstruction but no allergies, those with allergies but no nasal obstruction and those with neither nasal obstruction or allergies, who served as controls. Those in the nasal-obstruction groups (with or without allergies) had higher odds of snoring and daytime sleepiness than the control group, but there was no difference between the allergies-only and control groups.
"The present results strongly suggest that nasal obstruction causes sleep-disordered breathing and, thus, daytime sleepiness in individuals without allergic rhinitis as well as in those with allergic rhinitis," the authors write. This is thought to occur through several mechanisms, including changes in pressure that cause portions of the throat to collapse, functional difficulties induced by the shift from nasal breathing to mouth breathing and changes in signals sent from the respiratory system to the brain.
"We speculate that, although nasal obstruction itself is not a life-threatening condition, prompt and appropriate rhinologic treatment would improve sleep quality and, thus, daily and social activities in patients with sinonasal diseases," the authors conclude. "This remains to be further investigated in future studies."
(Arch Otolaryngol Head Neck Surg. 2008;134[12]:1254-1257. 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, December 15, 2008
Media Advisory: To contact corresponding authors Chuan-Mu Chen, Ph.D., e-mail: chchenl{at}dragon.nchu.edu.tw or Yun-Ting Chang, M.D., Ph.D., e-mail ytchang@vghtpe.gov.tw.
HIGHER LEVELS OF OBESITY-RELATED HORMONE FOUND IN PATIENTS WITH PSORIASIS
CHICAGO—Patients with the skin disease psoriasis appear more likely to have higher levels of leptin (a hormone produced by fat cells that may contribute to obesity and other metabolic abnormalities) than persons without psoriasis, according to a report in the December issue of Archives of Dermatology, one of the JAMA/Archives journals.
Psoriasis is an autoimmune disease that results in a red, scaly rash. "Associations among psoriasis, obesity, hypertension, cardiovascular diseases, diabetes mellitus and metabolic syndrome have been reported," the authors write as background information in the article. "Although the underlying mechanisms may be complex, the ‘obesity of psoriasis’ is thought to be a key link to cardiovascular diseases, including diabetes mellitus, stroke, heart disease, hypertension and myocardial infarction [heart attack]."
Yi-Ju Chen, M.D., of the Taichung Veterans General Hospital and National Chung Hsing University, Taiwan, and colleagues studied 77 patients with psoriasis and 81 individuals who were the same age and sex but did not have psoriasis. In 2006 and 2007, the researchers collected clinical characteristics of the participants, including age, sex, height, weight, any other diseases they had and the severity of their psoriasis. Blood samples were analyzed for levels of leptin, a hormone that helps control food intake, body weight and fat stores and also is related to immune and inflammatory processes.
Individuals with psoriasis were more likely than controls to be obese and to have hypertension (high blood pressure) and elevated blood glucose levels or diabetes. High blood levels of leptin were found more often in females, the obese and those with high blood pressure, metabolic syndrome (a grouping of cardiovascular risk factors that includes hypertension and high cholesterol) or psoriasis.
"After adjustment for sex, body mass index and conventional cardiovascular risk factors (including hypertension and metabolic syndrome), psoriasis was independently associated in our study with hyperleptinemia [high leptin levels]," the authors write. "In addition, hyperleptinemia in psoriasis is associated with higher risk of developing metabolic syndrome. This novel finding links the chronic inflammation status of psoriasis with metabolic disturbances."
The high circulating leptin levels in individuals with psoriasis may derive not only from fat tissue but also from inflammation, they continue. "Body weight loss has been reported to significantly decrease leptin levels and improve insulin sensitivity and may reduce the likelihood of developing metabolic syndrome and adverse cardiovascular diseases," the authors conclude. "Body weight loss could potentially become part of the general treatment of psoriasis, especially in patients with obesity."
(Arch Dermatol. 2008;144[12]:1571-1575. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by research grants from Taichung Veterans General 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, December 15, 2008
Media Advisory: To contact Dorothy A. Andriole, M.D., call Caroline Arbanas at 314-286-0109.
CERTAIN FACTORS ASSOCIATED WITH ATTRITION DURING GRADUATE MEDICAL EDUCATION TRAINING
CHICAGO—Graduates from a single medical school who began graduate medical education (residency) programs appear more likely to change specialty or discontinue graduate medical education training if they are academically highly qualified or are pursuing training in general surgery or a five-year surgical specialty, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals.
"Although it is possible to change specialties during graduate medical education (GME), failure of a resident to complete the stipulated period of GME can be a problem for both program directors and residents," according to background information in the article. "Such resident attrition, in which the resident discontinues GME in his or her initial specialty to pursue GME in a different specialty or to discontinue GME entirely, can have widespread ramifications, causing difficulties with program scheduling for remaining trainees and disruption of patient care delivery."
Dorothy A. Andriole, M.D., of the Washington University School of Medicine, St. Louis, and colleagues assessed GME enrollment and attrition of 795 students graduating from a single institution from 1994 to 2000. Participants planned to pursue training in a chosen specialty right after graduation from medical school or a year of preliminary training followed by entry into an advanced position. Students were considered as having high academic achievement if they had been elected to the Alpha Omega Alpha (AOA) Honor Medical Society or if they graduated with advanced degrees (such as combined M.D. – Ph.D. degrees).
After a minimum of six years of follow-up, 47 (6 percent) of the 795 participants did not complete GME in their initial specialty of choice. Of the 47 who discontinued training, 22 completed one year of training or less, 14 completed one to two years of training, and three completed more than two years of training in their initial specialty. "For many of the 41 graduates who continued GME in different specialties, there was an interval of up to several years before they resumed GME, often because they had pursued research in a desired specialty."
Attrition was not associated with graduation year, sex or age. However, "attrition was significantly associated with advanced degrees held at graduation, AOA election and specialty choice group," the authors write. "Four of the six graduates who entirely discontinued GME training held M.D. and Ph.D. degrees and subsequently pursued exclusively research-based careers."
"Finally, the issue of attrition during GME should be considered in the context of the projected physician shortage in the United States and growing concerns about the structure and efficiency of the GME process," they conclude. "Efforts to redesign unnecessarily circuitous or lengthy specialty-specific training paths and to minimize nondurable specialty choice decisions by our students could enhance the systemwide efficiency of GME at the national level."
(Arch Surg. 2008;143[12]:1172-1177. 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, December 15, 2008
Media Advisory: To contact Anne O. Lidor, M.D., M.P.H., contact Eric A. Vohr at 410-955-8665 or evohr1{at}jhmi.edu.
STUDY EXAMINES ASSOCIATION OF RACE AND INSURANCE STATUS WITH PRESENTATION AND SURGICAL TREATMENT OF DIVERTICULITIS
CHICAGO—Among patients undergoing surgery for diverticulitis, race was associated with a complicated presentation and in-hospital mortality, but not with receiving a colostomy, whereas insurance status was associated with complicated presentation, in-hospital mortality and receiving a colostomy, according to a report in the December issue of Archives of Surgery, one of the JAMA/Archives journals. The results suggest that racial disparities in outcomes may be related to the patients’ initial condition rather than differences in treatment.
Diverticulitis refers to inflammation and infection involving small outpouchings of the colon (known as diverticula) that can result in perforations (holes or breaks) in colon walls, according to background information in the article. The disease accounts for more than 200,000 hospitalizations and more than $300 million in health care costs each year. Diverticulitis is considered complicated if it is accompanied by bowel obstruction, hemorrhage, perforation or abscess formation.
"Complicated diverticulitis is managed by hospital admission, bowel rest, intravenous antibiotics, and, depending on the patient’s condition, either emergency surgery or conservative management," the authors write. Surgical interventions involve removing the diseased portion of the colon and reattaching the healthy sections. This can be done in one procedure or in a two-staged operation involving a colostomy (surgical opening through the abdominal wall to allow for waste removal). "The need for a colostomy usually relates to higher disease severity at presentation and is difficult for patients from a functional as well as emotional standpoint," the authors write.
Anne O. Lidor, M.D., M.P.H., and colleagues at Johns Hopkins University, Baltimore, analyzed the records of 45,528 patients with diverticulitis who were admitted to hospitals nationwide between 1999 and 2003. Of these, 85.3 percent were white, 5.3 percent were black and 6.7 percent were underinsured.
"In our study, we found that race did not affect the type of surgical treatment received for diverticulitis, notwithstanding that black patients were more likely than white patients to present with more complicated cases," the authors write. "In contrast, insurance status did correlate with the type of treatment provided. Uninsured and underinsured patients were more likely to receive a colostomy, even after adjusting for a higher rate of complicated diverticulitis in those patients than their insured counterparts."
The results suggest that a lack of adequate health insurance is a more powerful predictor of treatment patterns for patients with diverticulitis, the authors note. "This, to some degree, questions the conventional wisdom that race is the primary determinant of suboptimal outcomes in health care delivery and has obvious prescriptive implications for future health care policy decisions," they conclude. "To the extent to which these findings can be generalized to a variety of other medical conditions, a new paradigm of health care resource allocation may be in order, one based more on socioeconomic than racial distinctions. Future research should assess the means by which barriers to equal access to adequate health care can be reduced or eliminated by negating socioeconomic factors rather than emphasizing race-based distinctions."
(Arch Surg. 2008;143[12]:1160-1165. 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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