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, January 19, 2009)
Virtual Communities May Provide Valuable Support for Psoriasis Patients
Retinoid Cream Associated With Death in Clinical Trial, but Relationship Does Not Appear Causal
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 19, 2009)
MRSA Head and Neck Infections Increase Among Children
ARCHIVES OF FACIAL PLASTIC SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 19, 2009)
Victims of Intimate Partner Violence Display Distinct Patterns of Facial Injury
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, January 19, 2009)
Study Compares Two Non-Surgical Treatments for Reflux Disease
Racial Disparities in Survival Among Patients Diagnosed With Lung Cancer Decrease When Patients Given the Recommendation for Appropriate Treatment
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ON-LINE. Go to www.jamamedia.org for more information and to apply for access.
Please Note: The FOR THE MEDIA website now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 19, 2009
Media Advisory: To contact corresponding author Alice J. Watson, M.B.Ch.B., M.R.C.P., M.P.H., call Gina Cella at 781-334-4692 or e-mail ginacella{at}comcast.net.
Virtual Communities May Provide Valuable Support for Psoriasis Patients
CHICAGO—Online support communities appear to offer both a valuable educational resource and a source of psychological and social support for individuals with psoriasis, according to a report in the January issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Psoriasis currently affects approximately 0.6 percent to 4.8 percent of the world's population," according to background information in the article. In addition to causing skin and joint problems, psoriasis can also impair individuals' financial status and emotional, physical and sexual well-being. It is estimated that 10 percent of psoriasis patients have contemplated suicide. "As a result, it is a necessity to provide patients with access to psychological support."
Shereene Z. Idriss, B.A., and colleagues at the Center for Connected Health and Massachusetts General Hospital, Boston, assessed perceived benefits and usage of online psoriasis support groups among 260 adults who participated in one of five such groups (average age 40). Patients' disease characteristics and demographic information were also recorded.
Participants were mostly white (75.7 percent), female (60.4 percent) and college-educated (84.3 percent). "A total of 188 (73.7 percent) reported having moderate or more severe psoriasis, and 206 (79.9 percent) rated their current general health status as average or better," the authors write.
Availability of resources was cited as the key factor for use of an online support site. Convenience, access to good advice and lack of embarrassment when dealing with personal issues followed. Three-fourths of participants also named anonymity as an important feature of online support use. Almost half (49.5 percent) of participants perceived improvements in their quality of life and 41 percent perceived improvements in psoriasis severity since joining an online support community.
"Although online psoriasis support groups are still in their nascent stage, they have captured a loyal and growing audience," the authors conclude. "The dermatology community should consider leveraging the infrastructure of online support groups to build on delivering personalized and integrated medical care to individuals affected by psoriasis."
(Arch Dermatol. 2009;145[1]:46-51. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Center for Connected Health. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 19, 2009
Media Advisory: To contact Martin A. Weinstock, M.D., Ph.D., call James Burrows at 401-457-3004 or e-mail jim.burrows{at}va.gov, or call Mark Hollmer at 401-863-1862 or e-mail Mark_Hollmer{at}brown.edu. To contact editorial author Robert P. Dellavalle, M.D., Ph.D., M.S.P.H., call Christina White at 303-393-5205 or e-mail christina.white{at}va.gov.
Retinoid Cream Associated With Death in Clinical Trial, but Relationship Does Not Appear Causal
CHICAGO—Patients using a cream containing tretinoin, a retinoid commonly used to treat acne and other conditions, appeared more likely to die than those using a placebo in a clinical trial that was halted early as a result, according to a report in the January issue of Archives of Dermatology, one of the JAMA/Archives journals. However, evidence does not suggest these excess deaths were caused by the therapy.
"The potential of retinoid compounds to prevent cutaneous malignant lesions [skin cancers] has been of considerable interest, and some are effective for this purpose," the authors write as background information in the article. In 1998, the Veterans Affairs Topical Tretinoin Chemoprevention (VATTC) Trial was launched to assess whether high-dose therapy with a cream containing one such retinoid, tretinoin, could prevent cancer. A total of 1,131 veterans (97 percent men, average age 71) were randomly assigned to apply either a cream containing 0.1 percent tretinoin or an unmedicated cream daily to their face and ears. They were then examined by a dermatologist every six months, with a planned study end date of Nov. 15, 2004.
A report prepared for one of the study's several oversight committees in 2004 identified a statistically significant increase in the number of deaths among study participants in the group using tretinoin. The trial was therefore halted six months early, in May 2004. Martin A. Weinstock, M.D., Ph.D., of the VA Medical Center and Brown University, Providence, R.I., and colleagues assessed the data collected during the study to assess the relation of the medication to death risk.
Because death was not an end point in the original study, additional efforts were made to identify study participants who had died and gather more information about cause of death, including accessing the VA master death file. Through these records and original study data, researchers identified 108 patients in the tretinoin group and 76 in the control group who died before the end of the intervention period and an additional 14 in each group who died before the end of the study period (November 2004). After considering other factors that might increase the risk of death—including smoking, age and co-occurring illnesses—there was still a significantly higher risk of death in the treatment group.
However, additional analyses did not support tretinoin as a cause of death. For example, there was no clear association between the number of tubes of cream used and death. There was no consistency in the causes of death among participants. However, in the treatment group, 15 patients died of non-small cell lung cancer, 12 of vascular disorders and 15 of respiratory and other chest disorders—causes associated with smoking, which some previous studies have suggested interacts with compounds in some ways similar to tretinoin, but administered systemically, to produce additional health risks. Participants were asked whether they smoked, but their smoking status was not verified, potentially affecting the detected associations.
"The biological implausibility, lack of specificity of causes of death, inconsistency with previous experience, weakness of other supportive evidence in our data and weak statistical signal cast doubt on a potential causal association of topical tretinoin with death in the VATTC Trial," the authors write. "We do not conclude that this trial provides appropriate grounds for hesitating to use topical tretinoin in clinical practice in the absence of additional evidence."
(Arch Dermatol. 2009;145[1]:18-24. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by the Cooperative Studies Program (CSP) of the Office of Research and Development, U.S. Department of Veterans Affairs, and the American Cancer Society. OrthoNeutrogena, a division of Ortho-McNeil Pharmaceutical Inc., provided the tretinoin, 0.1 percent, and the vehicle creams. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Physicians Should Discuss Results With Patients
"Public health ideally uses the precautionary principle—that possible harm should be avoided before harmful effects are unquestionably proven," write Lisa M. Schilling, M.D., M.S.P.H., and Robert P. Dellavalle, M.D., Ph.D., M.S.P.H, of the Department of Veterans Affairs Medical Center, Denver, in an accompanying editorial.
"At a minimum, this principle should cause prescribing physicians to discuss the results of the VATTC with elderly men using topical tretinoin," they write. "More circumspect practitioners may wish to discuss the results of the VATTC with all patients using topical tretinoin. This dialogue should include that the results of the VATTC may have been due to chance, but also that the outcome of death was not initially anticipated, and owing to the ad hoc analysis, various important risk factors, such as smoking status, might not have been completely ascertained. These discussions provide an opportunity for all health care providers prescribing tretinoin to emphasize tobacco prevention and cessation with their patients."
(Arch Dermatol. 2009;145[1]:76. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported in part by Colorado Health Informatics Collaboration Academic Enrichment Funds from the University of Colorado Denver School of Medicine and a Cancer Prevention and Control Career Development Award grant. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 19, 2009
Media Advisory: To contact corresponding author Steven E. Sobol, M.D., M.Sc., call Kathi Baker at 404-727-9371 or e-mail kobaker{at}emory.edu.
MRSA Head and Neck Infections Increase Among Children
CHICAGO—Rates of antibiotic-resistant head and neck infections increased in pediatric patients nationwide between 2001 and 2006, according to a report in the January issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
Before the 1980s, infections with strains of the bacteria Staphylococcus aureus resistant to the antibiotic methicillin (methicillin-resistant Staphylococcus aureus, or MRSA) were most often acquired in the hospital, according to background information in the article. However, during the past decade, community-acquired MRSA infections have become more common in prisons, nursing homes and among chronically ill patients and in individuals without established risk factors. "Staphylococcus aureus is a pathogen commonly seen in many infections involving the head and neck," the authors write. "In recent years, there have been increasing reports of community-acquired MRSA infections in children."
Iman Naseri, M.D., of Emory University School of Medicine, Atlanta, and colleagues reviewed data regarding pediatric head and neck infections that occurred at more than 300 hospitals nationwide between 2001 and 2006. Sites of infection were divided into oropharyngeal/neck (head and neck), sinonasal (nose and sinuses) and otologic (ear), and demographic and antibiotic resistance patterns were reviewed.
Of 21,009 S. aureus infections that occurred during this period, 21.6 percent (4,534) were resistant to methicillin. MRSA rates increased from 11.8 percent in 2001 to 28.1 percent in 2006. "This represents a 16.3-percent increase in MRSA during these six years for all pediatric head and neck S. aureus infections," the authors write.
Among the three groups of infection sites, the highest proportion of MRSA was found in the ears (34 percent), followed by the sinonasal (28.3 percent) and the head and neck (14.2 percent) groups. Regional differences were also found, which could be attributed to geographical disparities in the treatment of head and neck infections.
"Judicious use of antibiotic agents and increased effectiveness in diagnosis and treatment are warranted to reduce further antimicrobial drug resistance in pediatric head and neck infections," the authors write.
"Expeditious culture of suspected head and neck infections leading to more appropriate antimicrobial drug selection is highly recommended to avoid further resistant patterns," they conclude. "Further studies linking the microbiologic and clinical behaviors of MRSA are warranted to gain additional insight into the dynamic existence of this organism."
(Arch Otolaryngol Head Neck Surg. 2009;135[1]:14-16. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: An unrestricted educational research grant from Alcon Laboratories Inc. supported all phases of this large, multi-institutional study, including funding for research supplies, data acquisition and data analysis and interpretation. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 19, 2009
Media Advisory: To contact Oneida A. Arosarena, M.D., call Megan Chiplock at 215-707-1731 or e-mail chiplock{at}temple.edu.
Victims of Intimate Partner Violence Display Distinct Patterns of Facial Injury
CHICAGO—Women who are victims of intimate partner violence tend to have different patterns of facial injury than women who experience facial trauma from other causes, according to a report in the January/February issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. This information, and other key characteristics such as a delay before visiting a health care facility, could help surgeons and other physicians recognize patients who are victims of this type of abuse.
Intimate partner violence—abuse by a spouse or significant other—affects approximately 25 percent to 33 percent of women in the United States, according to background information in the article. Between 88 percent and 94 percent of intimate partner violence victims seek medical attention for injuries to the head and neck, and 56 percent of those have facial fractures. "Because intimate partner violence accounts for 34 percent to 73 percent of facial injuries in women, facial plastic surgeons and other health care providers who treat patients with maxillofacial injuries are in a unique position to identify these victims and refer them to local domestic violence service programs for safety planning, information and referrals, support services and advocacy, depending on the victims' needs and choices," the authors write.
Oneida A. Arosarena, M.D., of the Temple University School of Medicine, Philadelphia, and colleagues reviewed the medical and dental records of 326 women (average age 35 years) treated for facial trauma at one university medical center between 1998 and 2004. Of the 45 patients (13.8 percent) who were assault victims, 18 were documented victims of intimate partner violence, while 24 of the remaining 26 assault victims could not or did not identify their assailant. Other common causes of injury included motor vehicle crashes (139 patients, or 42.6 percent), falls (70 patients, or 21.5 percent) and unknown or undocumented causes (35 patients, or 10.7 percent).
Overall, assault was associated with mandible (jaw) fractures, zygomatic complex fractures (complicated breaks in the cheekbones), orbital blow-out fractures (cracks or breaks in bones surrounding the eye) and intracranial (brain) injury. "Specifically, higher than expected numbers of zygomatic complex fractures, orbital blow-out fractures and intracranial injuries were found in intimate partner violence victims," the authors write. "Victims assaulted by unknown or unidentified assailants were more likely to have mandible fractures than were other assault victims."
Results of the study indicate that about one in four women at risk for ongoing intimate partner violence was referred for protective service as required by state law and hospital policy. "Underreporting of intimate partner violence remains a hindrance to appropriate social intervention for many victims," the authors write. "While our study was limited to facial trauma victims, it demonstrates that universal screening and examination of the patterns of presentation, including patterns of injury, can assist medical professionals in identifying these patients and initiating appropriate medical and social intervention."
(Arch Facial Plast Surg. 2009;11[1]:48-52. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 19, 2009
Media Advisory: To contact Louis O. Jeansonne IV, M.D., call Amiee Goforth at 504-842-4303 or e-mail agoforth{at}ochsner.org.
Study Compares Two Non-Surgical Treatments for Reflux Disease
CHICAGO—Two non-surgical, non-pharmacological treatments for gastroesophageal reflux disease (GERD) both appear effective in reducing medication use and improving voice and swallowing symptoms, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals. One type of therapy also appears effective for reducing heartburn and cough, whereas the other may be associated with a reduction in regurgitation.
GERD—a condition in which acid from the stomach backs up into the esophagus—is typically treated first with medications such as proton pump inhibitors, according to background information in the article. However, it may be difficult for patients to comply with or afford long-term drug therapy, and GERD returns more than 80 percent of the time when medication is discontinued. Surgical options have been available since the 1990s, and more recently, endoluminal therapies that involve entering through the body’s natural passages to repair the underlying causes of GERD have become available.
One endoluminal therapy, full-thickness plication, involves using a long, narrow tool known as an endoscope to tighten the junction between the esophagus and the stomach with sutures. A second, radiofrequency therapy, delivers energy waves to the muscles of the esophagus and stomach, purportedly improving the function of the valve between the esophagus and the stomach. Louis O. Jeansonne IV, M.D., then of Emory University School of Medicine, Atlanta, and now at Ochsner Medical Center, Baton Rouge, La., and colleagues compared the effectiveness of these two therapies in 126 patients treated for GERD between 2002 and 2006.
For the first two years of the study, only radiofrequency was available; for the remainder, treatment decisions were based on patient preference, the surgeon's judgment and anatomical factors. A total of 68 patients underwent radiofrequency treatment and 58 underwent full-thickness plication. Patients were asked to report their medication use and rate their GERD symptoms before and after the procedure.
After an average of six months, follow-up data was obtained for 51 percent of patients. Among those who underwent radiofrequency treatment, on follow-up the percentage with moderate to severe heartburn decreased from 55 percent to 22 percent; medication use decreased from 84 percent to 50 percent; and decreases were also seen for swallowing difficulties, voice symptoms and cough. In the full-thickness plication group, moderate to severe heartburn decreased from 53 percent to 43 percent of patients; medication use decreased from 95 percent to 43 percent; and decreases were seen for regurgitation, voice symptoms and swallowing difficulties. There were no changes in chest pain or asthma symptoms after treatment in either group.
"Our experience indicates that radiofrequency and full-thickness plication are both effective, providing symptomatic relief and reduction in proton pump inhibitor use," the authors conclude. "For patients whose chief complaint is regurgitation, full-thickness plication may be the preferred procedure. Further study is needed to determine the long-term effectiveness of endoluminal treatments."
(Arch Surg. 2009;144[1]:19-24. 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.
Go back to the top.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, January 19, 2009
Media Advisory: To contact corresponding author David R. Flum, M.D., M.P.H., call Mary Guiden at 206-616-3192 or e-mail mguiden{at}u.washington.edu.
Racial Disparities in Survival Among Patients Diagnosed With Lung Cancer Decrease When Patients Given the Recommendation for Appropriate Treatment
CHICAGO—Disparities in survival among black patients diagnosed with early-stage lung cancer are not seen when patients are recommended appropriate treatment, according to a report in the January issue of Archives of Surgery, one of the JAMA/Archives journals.
Lung cancer causes more deaths in the United States than any other cancer, according to background information in the article. Pulmonary resection—or surgery to remove a portion of the lung—provides the best chance for patients with early-stage disease to be cured. "Black patients with early-stage lung cancer have lower five-year survival rates than white patients, and this difference in outcome has been attributed to lower rates of resection among black patients," the authors write. "Several potential factors underlying racial differences in the receipt of surgical therapy include differences in pulmonary function, access to care, refusal of surgery, beliefs about tumor spread on air exposure at the time of operation and the possibility of cure without surgery, distrust of the health care system and physicians, suboptimal patterns of patient and physician communication and health care system and provider biases." Of these, access to care is often considered the most important of factors underlying racial disparities.
Farhood Farjah, M.D., M.P.H., of the University of Washington, Seattle, and colleagues designed a study to address whether differences in survival persist when evaluating only patients who had been recommended to receive optimal therapy, in this case lung resection. Patients recommended for therapy were considered likely to have "cleared" at least one major hurdle of access to care. The investigators analyzed data from 17,739 patients who were diagnosed with lung cancer between 1992 and 2002 (average age 75, 89 percent white and 6 percent black) and who were recommended to receive surgical therapy. They tracked whether or not the patients underwent surgery, and their overall survival, through 2005.
While black patients recommended to surgery had lung resections less frequently than white patients (69 percent vs. 83 percent, the authors write. After adjustment, there was no significant association between race and death.
Several possible explanations exist for the differences in rates of surgery, the authors note, and these may be important for understanding patient decision-making and improving care delivery systems. Black patients may be more likely to refuse surgery than white patients, or may have more limited access to recommended care.
"Although these findings do not refute the likely roles of health care system and provider biases and patient characteristics as important causal factors underlying health disparities, the findings do suggest that other factors (i.e., distrust, perceptions and beliefs about lung cancer and its treatment and limited access to subspecialty care) may have a more dominant role in causing disparities than previously recognized. The implication of these findings is that interventions designed to narrow gaps in health care should target structural aspects of care, providers and patients and communities at risk for lung cancer and suboptimal care." The study findings suggest that referral of all patients with potentially curable lung cancer for consideration of lung resection may be a helpful tool in mitigating previously identified racial differences in survival.
(Arch Surg. 2009;144[1]:14-18. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: Dr. Farjah was supported by a Cancer Epidemiology and Biostatistics Training Grant and a Ruth L. Kirschstein National Research Service Award from the National Cancer Institute. Additional resources were available through the Department of Surgery and the Surgical Outcomes Research Center, University of Washington and the generosity of the Schilling family. 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.
Go back to the top.
