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, February 5, 2008)
JAMA NEWS RELEASES
SMOKING MARIJUANA ASSOCIATED WITH INCREASED RISK FOR GUM DISEASE
PATIENTS APPEAR TO BE AT INCREASED RISK OF ADVERSE EVENTS WITHIN 3 MONTHS AFTER STOPPING CLOPIDOGREL THERAPY FOR ACUTE CORONARY SYNDROME
'MINIMALLY INVASIVE' BIOPSY METHODS MAY PROVIDE AN ACCURATE APPROACH FOR DISEASE STAGING IN PATIENTS WITH SUSPECTED LUNG CANCER
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
STUDY FINDS MARIJUANA SMOKING IS RISK FACTOR FOR GUM DISEASE
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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 5, 2008
Media Advisory: To contact W. Murray Thomson, Ph.D., email: murray.thomson{at}otago.ac.nz. To contact co-author James D. Beck, Ph.D., call Deborah Saine at 919-966-8512. To contact editorial author Philippe P. Hujoel, Ph.D., call Clare Hagerty at 206-685-1323.
SMOKING MARIJUANA ASSOCIATED WITH INCREASED RISK FOR GUM DISEASE
CHICAGO—Regular use of marijuana (cannabis) in young adulthood is associated with periodontal (gum) disease, according to a study in the February 6 issue of JAMA.
Periodontal disease is one of the most common chronic diseases in adults, with inflammation that can extend deep into the dental tissues, causing loss of supporting connective tissue and possible loss of teeth. Tobacco smoking is recognized as the primary behavioral risk factor for the condition, and it is thought cannabis smoking may have a similar effect, according to background information in the article.
W. Murray Thomson, Ph.D., of the Dunedin School of Medicine, Dunedin, New Zealand, and colleagues conducted a study to determine whether cannabis smoking is a risk factor for periodontal disease. The study included 903 participants who were born in Dunedin in 1972 and 1973 and assessed periodically: cannabis use was determined at ages 18, 21, 26, and 32 years and dental examinations were conducted at ages 26 and 32 years. The most recent data collection (at age 32 years) was completed in June 2005. Three cannabis exposure groups were determined: no exposure (293 individuals, or 32.3 percent), some exposure (428; 47.4 percent), and high exposure (182; 20.2 percent). Some exposure was defined as an average of 1-40 occasions of cannabis use reported during the years assessed; high exposure as an average of 41 or more occasions of cannabis use during those years.
At age 32 years, 265 participants (29.3 percent) had one or more sites with 4 mm or greater periodontal combined attachment loss (CAL; loss of periodontal tissue), and 111 participants (12.3 percent) had one or more sites with 5 mm or greater CAL. New attachment loss between the ages of 26 and 32 years in the none, some, and high cannabis exposure groups was 6.5 percent, 11.2 percent, and 23.6 percent, respectively. After controlling for tobacco smoking (measured in pack-years), sex, irregular use of dental services, and dental plaque, compared with those who had never smoked cannabis, those in the highest cannabis exposure group had a 60 percent increased risk for having one or more sites with 4 mm or greater CAL; a 3.1 times greater risk for having one or more sites with 5 mm or greater CAL; and a 2.2 times increased risk for having new attachment loss.
Tobacco smoking was strongly associated with periodontal disease, but there was no interaction between cannabis use and tobacco smoking in predicting the condition’s occurrence.
"The study’s demonstration of a strong association between cannabis use and periodontitis experience by age 32 years indicates that long-term smoking of cannabis is detrimental to the periodontal tissues and that public health measures to reduce the prevalence of cannabis smoking may have periodontal benefits for the population," the authors write.
"Although definitively establishing the periodontal effects of exposure to cannabis smoke should await confirmation in other populations and settings, health promoters and dental and medical practitioners should take steps to raise awareness of the strong probability that regular cannabis users may be doing damage to the tissues that support their teeth."
(JAMA. 2008;299[5]:525-531. 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.
EDITORIAL: DESTRUCTIVE PERIODONTAL DISEASE AND TOBACCO AND CANNABIS SMOKING
In an accompanying editorial, Philippe P. Hujoel, Ph.D., of the University of Washington, Seattle, comments on the findings regarding cannabis use and periodontal disease.
"...Thomson and colleagues have reported findings indicating that smoking of tobacco and potentially cannabis are associated with evidence of destructive periodontal disease that can be detected in early adulthood, long before other smoking-related diseases such as diabetes, cardiovascular disease, and certain cancers become apparent. Given the high prevalence of dental care in the young population in the United States, the dental profession has an opportunity to detect the early clinical signs of unhealthy lifestyles, including potential drug abuse, and could play a role with physicians in addressing the challenges of reducing chronic noncommunicable diseases."
(JAMA. 2008;299[5]:574-575. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including 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, February 5, 2008
Media Advisory: To contact corresponding author John S. Rumsfeld, M.D., Ph.D., call Christina White at 303-393-5205.
PATIENTS APPEAR TO BE AT INCREASED RISK OF ADVERSE EVENTS WITHIN 3 MONTHS AFTER STOPPING CLOPIDOGREL THERAPY FOR ACUTE CORONARY SYNDROME
CHICAGO—Patients who receive the anti-platelet medication clopidogrel following an acute coronary syndrome (such as heart attack) appear to be at greater risk of a heart attack or death in the first 90 days after stopping clopidogrel treatment, according to a study in the February 6 issue of JAMA.
Randomized trials have established the effectiveness of clopidogrel therapy following hospitalization for acute coronary syndrome (ACS) for patients treated either medically or with percutaneous coronary intervention (PCI - procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries). Current cardiology guidelines recommend clopidogrel therapy for ideally up to 1 year for patients treated medically or with a bare metal stent, according to background information in the article. It is unknown whether there may be a "rebound effect" or concentration of thrombotic events shortly after stopping treatment with clopidogrel, as has been found for patients after long-term aspirin therapy.
P. Michael Ho, M.D., Ph.D., of the Denver VA Medical Center, Denver, and colleagues assessed the incidence and timing of death or acute myocardial infarction (AMI; heart attack) after stopping treatment with clopidogrel in a group of 3,137 patients with ACS discharged from 127 Veterans Affairs hospitals. Average follow-up after stopping treatment with clopidogrel was 196 days for medically treated patients with ACS without stents (n = 1,568) and 203 days for patients with ACS treated with PCI (n = 1,569).
Among the medically-treated patients, the average duration of clopidogrel treatment was 302 days. The researchers found that all-cause death (n = 155) or AMI (n = 113) occurred in 17.1 percent (n = 268) of patients, with 60.8 percent (n = 163) of events occurring during 0 to 90 days, 21.3 percent (n = 57) occurring during 91 to 180 days, and 9.7 percent (n = 26) occurring during 181 to 270 days after stopping treatment with clopidogrel. Further analysis indicated that the interval of 0 to 90 days was associated with nearly twice the risk of adverse events after stopping treatment with clopidogrel compared with the interval of 91 to 180 days.
Among the PCI-treated patients, average duration of clopidogrel treatment was 278 days. All-cause death (n = 68) or AMI (n = 56) occurred in 7.9 percent (n = 124) of the patients, with 58.9 percent (n = 73) of the events occurring during 0 to 90 days, 23.4 percent (n = 29) occurring during 91 to 180 days, and 6.5 percent (n = 8) occurring during 181 to 270 days after stopping treatment with clopidogrel. After adjustment for total duration of clopidogrel treatment following hospital discharge, the interval of 0 to 90 days after stopping treatment with clopidogrel was associated with an 82 percent increased risk of adverse events compared with the interval of 91 to 180 days.
The authors write that there is in vitro and physiological evidence to support a short-term increase in platelet activation and associated thrombotic risk immediately after stopping antiplatelet therapy.
"There are several potential implications of this study. Even though the absolute event rates were low, the relative increase in adverse events in the early period after stopping treatment with clopidogrel was nearly 2-fold higher than later periods. In addition, the absolute number of adverse events attributable to this event clustering is significant when extrapolated to a population level, considering the number of patients admitted with ACS and discharged with posthospital treatment with clopidogrel therapy both in the United States and worldwide."
"These findings, however, do not necessarily offset the benefits of clopidogrel therapy. Rather, additional studies are needed to confirm the presence of the event clustering after cessation of clopidogrel and to better understand the pathophysiology of this phenomenon. If these findings are subsequently confirmed, guideline recommendations may need to be reconsidered in terms of duration of clopidogrel therapy and perhaps the means of drug cessation," the researchers conclude.
(JAMA. 2008;299[5]:532-539. 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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Embargoed for Release: 3:00 p.m. CT, Tuesday, February 5, 2008
Media Advisory: To contact Michael B. Wallace, M.D., M.P.H., call Kevin Punsky at 904-953-2299.
'MINIMALLY INVASIVE' BIOPSY METHODS MAY PROVIDE AN ACCURATE APPROACH FOR DISEASE STAGING IN PATIENTS WITH SUSPECTED LUNG CANCER
CHICAGO—An evaluation of several endoscopic biopsy methods suggests that a "minimally invasive" approach may accurately determine the stage of suspected lung cancer, according to a study in the February 6 issue of JAMA.
Lung cancer is the most common cancer-related cause of death in the United States. Determining the stage of the disease is a critical factor regarding therapy and prognosis, according to background information in the article.
"Noninvasive staging with chest computed tomography (CT) or positron emission tomography (PET) is associated with high rates of false-positive and false-negative results, respectively. The American College of Chest Physicians recommends invasive staging with tissue confirmation of suspected metastatic mediastinal [center part of the thoracic cavity] lymph nodes. Mediastinoscopy or thoracoscopy [a surgical procedure that requires incisions] has been the diagnostic standard, but less invasive methods have emerged as potential alternatives," the authors write.
Such methods include blind transbronchial needle aspiration (TBNA), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and, more recently, endobronchial ultrasound-guided fine-needle aspiration (EBUS-FNA).
Michael B. Wallace, M.D., M.P.H., of Mayo Clinic, Jacksonville, Fla., and colleagues compared the diagnostic accuracy of these three methods (and their combinations). Among 138 patients with suspected lung cancer who met all study criteria, 42 (30 percent) had malignant lymph nodes.
The researchers found that EBUS-FNA had higher sensitivity than TBNA (69 percent vs. 36 percent), detecting 29 (vs. 15) of the 42 malignant lymph nodes. EUS plus EBUS had higher estimated sensitivity (93 percent [39/42]) than any of the other methods. Compared with either EUS-FNA or EBUS-FNA alone, the combination identified 10 more malignant lymph nodes, with sensitivity estimated to be 24 percent higher than either approach alone.
The percentage of malignant lymph nodes detected by each procedure (number malignant/total number sampled) was 15 percent for TBNA, 19.7 percent for EBUS-FNA, and 22 percent for EUS-FNA. EUS plus EBUS also had higher sensitivity for detecting lymph nodes in any mediastinal location and for patients without lymph node enlargement on chest CT.
"If mediastinoscopy had been performed only when results from EUS plus EBUS were negative, this surgical procedure would have been avoided in 28 percent (39/138) of patients in this study. If EUS plus EBUS had been used to completely replace mediastinoscopy (100 percent of patients), 97 percent would have been correctly labeled as negative," the authors write.
"If these data are confirmed by other studies, they thus suggest that EUS plus EBUS may be an alternative method for surgical staging of the mediastinum in patients with suspected lung cancer."
(JAMA. 2008;299[5]:540-546. 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
STUDY FINDS MARIJUANA SMOKING IS RISK FACTOR FOR GUM DISEASE
INTRO:
Studies have shown that cigarette smoking is a leading cause of gum disease among many adults. Now new research indicates smoking marijuana may also be a risk factor even if you don’t smoke cigarettes. Jennifer Mitchell explains in this week’s JAMA Report.
VIDEO:
Dentist working on patient
AUDIO:
SMOKING MARIJUANA COULD BE LEADING TO SERIOUS GUM DISEASE BUT ACCORDING TO PERIODONTIST, DR. PETER CABRERA, YOU MAY NOT KNOW IT UNTIL IT’S TOO LATE.
VIDEO:
SOT/FULL
@:11
Super: Peter Cabrera, D.D.S.
Periodontist
Runs :12
AUDIO:
“Because smoking destroys circulation in essence it’s making the problem worse and it’s hiding it at the same time.”
VIDEO:
B-ROLL
Researcher at table
pictures of gum disease
AUDIO:
DR MURRAY THOMSON AND HIS COLLEAGUES AT SIR JOHN WALSH RESEARCH INSTITUTE SCHOOL OF DENTISTRY IN NEW ZEALAND COMPARED MARIJUANA SMOKING AND GUM DISEASE IN ABOUT 900 YOUNG ADULTS BETWEEN THE AGES OF EIGHTEEN AND THIRTY-TWO.
VIDEO:
SOT/FULL
@:34
Super:Murray Thomson, Ph.D.
Sir John Walsh Research Institute
Runs :14
AUDIO:
“When we looked at the new cases of gum disease between twenty-six and thirty-two, fully one third of those new cases were due to cannabis smoking. That really surprised us.”
VIDEO:
B-ROLL
Full screen graphic
Marijuana & Gum Disease Study (have each line reveal)
Heavy marijuana smokers
Smoking 1 time week or more
Gum disease risk = (up arrow) 3 x
Some never smoked cigarettes
GFX/JAMA COVER
AUDIO:
HEAVY SMOKERS, THOSE WHO SMOKED MARIJUANA AT LEAST ONCE A WEEK, WERE THREE TIMES MORE LIKELY TO DEVELOP GUM DISEASE THAN THOSE WHO NEVER SMOKED POT. IT’S IMPORTANT TO POINT OUT THAT SOME OF THESE HEAVY MARIJUANA SMOKERS NEVER SMOKED CIGARETTES. THE FINDINGS APPEAR THIS WEEK IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.
VIDEO:
SOT/FULL
Murray Thomson, Ph.D.
Sir John Walsh Research Institute
Runs :11
AUDIO:
“It’s not the effect of the smoke directly on the gums, it’s the effect of the toxins being absorbed from the smoke that’s sucked down into the lungs”
VIDEO:
B-ROLL
Pictures of gums and teeth
Picture of mouth with some teeth missing
AUDIO:
THOSE TOXINS BREAKDOWN THE GUMS ABILITY TO HEAL LEADING TO INFECTION, GUM AND BONE LOSS, AND EVENTUALLY YOU’LL BEGIN TO LOSE TEETH.
VIDEO:
SOT/FULL
Peter Cabrera, D.D.S.
Periodontist
Runs :09
AUDIO:
“You’ve lost half the bone support of that tooth at a young age so when you’re in your forties and fifties you’re likely to have lost a significant number of your teeth.”
VIDEO:
B-ROLL
researcher looks at book then walks
Tight of mouth
Periodontist working on patient
AUDIO:
RESEARCHERS HOPE THE FINDINGS WILL ENCOURAGE MARIJUANA USERS TO STOP SMOKING, POINTING OUT THAT PROLONGED GUM DISEASE, IF LEFT UNTREATED, CAN LEAD TO EVEN MORE SERIOUS HEALTH PROBLEMS. JENNIFER MITCHELL, THE JAMA REPORT.
TAG:
Researchers say the study demonstrates that what we do in our younger years does make a difference later in life in terms of our health. The study was conducted in New Zealand from 1990 through 2005. For more information, visit www.jama.com.
