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, February 16, 2009)
Study Evaluates Types of Skin Diseases Among Military Personnel Who Were Evacuated from Combat Zones
Sun-Safe Pool Policies Appear Related to Sun Safety Behaviors Among Pool Staff
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 16, 2009)
Many Children With Hearing Loss Also Have Eye Disorders
Video Imaging Provides Dynamic View of Airway Obstruction in Those With Sleep Breathing Disorder
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, February 16, 2009)
Survival After Surgical Complications Appears Better at Teaching Hospitals for Whites but Not Blacks
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EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, February 16, 2009
Media Advisory: To contact Timothy A. McGraw, M.D., call Ken Frager at 301-295-3981 or e-mail kenneth.frager.ctr{at}usuhs.mil.
Study Evaluates Types of Skin Diseases Among Military Personnel Who Were Evacuated from Combat Zones
CHICAGO—Dermatitis, benign moles, hives and cancerous skin lesions are among the most common diagnoses among a group of military personnel who were evacuated from combat zones for ill-defined dermatologic diseases, according to a report in the February issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Throughout the history of warfare, dermatologic diseases have been responsible for troop morbidity, poor morale and combat ineffectiveness," the authors write as background information in the article. In tropical and subtropical climates, skin diseases have accounted for more than half of the days lost by frontline units. Skin diseases during wartime are exacerbated by sun exposure, temperature and humidity extremes, native diseases, insects, crowded living conditions, difficulty maintaining personal hygiene and chafing and sweating caused by body armor, helmets and other protective gear.
Timothy A. McGraw, M.D., of the Uniformed Services University of the Health Sciences, Bethesda, Md., and Pentagon Air Force Flight Medicine Clinic, Washington, D.C., and Scott A. Norton, M.D., M.P.H., also of the Uniformed Services University of the Health Sciences, studied 170 military personnel who left combat zones in central and southwest Asia for ill-defined dermatologic reasons between 2003 and 2006 (for example, non-specific skin eruption or skin disorder, not otherwise specified).
Of these, 154 (91 percent) were evaluated by a dermatologist after evacuation, and the rest were evaluated by other types of physicians, including family physicians and internal medicine specialists. A total of 34, or 20 percent, were diagnosed with dermatitis or general skin inflammation; 16, or 9 percent, with benign melanocytic nevus (non-cancerous moles); 13, or 8 percent, with a malignant neoplasm (cancerous skin lesions); and 11, or 7 percent, received an uncertain final diagnosis. Other common diagnoses included atopic dermatitis (chronic itchy rash), eczema, urticaria (hives) and psoriasis.
"Although skin diseases cause few fatalities, they have an appreciable role in combat and operational primary care," the authors write. "Our 'mystery rash' series illustrates the dermatologic diagnoses that are troublesome for both patients and clinicians in U.S. Central Command. The results of this study largely agree with observations from the first Persian Gulf War and in other 20th-century American and British conflicts: eczemateous and atopic dermatitis and other chronic skin conditions continue to be among the most common reasons that deployed military personnel seek dermatologic care."
Identifying individuals with these conditions before deployment, emphasizing preventive measures and developing treatment plans may reduce the number of evacuations and their resulting impact on combat units, the authors recommend. Efforts should also be made to improve the accuracy of dermatologic diagnoses in the combat zone, perhaps by creating virtual dermatology clinics so that off-site specialists can provide consultation and support.
(Arch Dermatol. 2009;145[2]:165-170. 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, February 16, 2009
Media Advisory: To contact Dawn M. Hall, M.P.H., call Ashanté Dobbs at 404-727-5692 or e-mail adobbs2{at}emory.edu.
Sun-Safe Pool Policies Appear Related to Sun Safety Behaviors Among Pool Staff
CHICAGO—The social environment at swimming pools appears to be related to sun safety behaviors of outdoor pool staff, according to a report in the February issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Skin cancer accounts for almost half of all cancers diagnosed in the United States, and there is both direct and indirect evidence that sun exposure can cause skin cancer," according to background information in the article. Outdoor lifeguards and aquatic instructors are particularly at high risk for overexposure to the sun because they are young and because they work outdoors. Sunburn tends to be common among young adults in high school and college due to poor sun protection habits. "About 50 percent of aquatic staff had a history of severe sunburn and almost 80 percent had experienced sunburn the previous summer."
"Interventions in the workplace may be effective for reducing sun exposure and improving sun protective behaviors of outdoor workers, but there are few published reports of sun protection interventions in occupational settings and inconsistent findings across those reports," the authors note.
Dawn M. Hall, M.P.H., and colleagues at the Rollins School of Public Health, Emory University, Atlanta, studied data collected from the Pool Cool skin cancer prevention program to analyze the associations among the pool environment, social norms and outdoor lifeguards' and aquatic instructors' sun protection habits and sunburns in 2001 and 2002. Demographic information was also noted.
A total of 191 pools participated in the program during one or both summers. There were 699 participants in 2001 and 987 participants in 2002 (ages 15 to 60). Most participants were white and female and more than half were between the ages of 15 and 19.
More than 80 percent of respondents reported habitually wearing sunglasses and more than 60 percent reported wearing sunscreen regularly, while less than half reported regularly using a shirt with sleeves, staying in the shade or wearing a hat while exposed to the sun. More than 60 percent of participants taught the Pool Cool sun safety lessons each year. "There was a trend toward fewer sunburns as social norms, pool policies and participation in the Pool Cool program increased, but results differed across the two years," the authors write. "In 2001, lower social norms scores and pool policy scores were associated with more reported sunburns. In 2002, teaching Pool Cool sun safety lessons was associated with fewer sunburns."
"Healthy sun protection behaviors among one's peers will likely have a positive influence on an individual's sun safety habits," they conclude. "Furthermore, sun-safe pool policies also foster healthier sun safety behaviors among the staff while they are at work and create a work environment conducive to developing health sun protection habits."
(Arch Dermatol. 2009;145[2]:139-144. Available to the media pre-embargo at www.jamamedia.org).
Editor's Note: This study was supported by a National Cancer Institute grant. 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, February 16, 2009
Media Advisory: To contact corresponding author David H. Chi, M.D., call Marc Lukasiak at 412-692-7919 or e-mail marc.lukasiak{at}chp.edu
Many Children With Hearing Loss Also Have Eye Disorders
CHICAGO—About one-fifth of children with sensorineural hearing loss also have ocular disorders, according to a report in the February issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
An estimated one to three per 1,000 children have some degree of sensorineural hearing loss, which occurs as a result of damage to the nerves or the inner ear, according to background information in the article. Half of all cases in children result from environmental causes and half from genetic causes; one gene, GJB2, accounts for a large proportion of sensorineural hearing loss cases in white patients.
"Especially early in life, sensorineural hearing loss is associated with delays in language, speech, cognitive and social development," the authors write. "Given the effects of hearing impairment, children with sensorineural hearing loss are particularly dependent on other means of information acquisition. If these children were to have unrecognized ophthalmologic abnormalities that limited visual acuity, there could be further detrimental effects on development."
Arun Sharma, M.D., of the University of Washington, Seattle, and colleagues reviewed ophthalmologic findings in 226 patients with sensorineural hearing loss who were seen at a children's hospital between 2000 and 2007. Of these, 49 (21.7 percent) had an ophthalmologic abnormality, including 23 (10.2 percent) with refractive errors (including nearsightedness, farsightedness and astigmatism) and 29 (12.8 percent with non-refractive errors. The cause of sensorineural hearing loss was syndromic (having other symptoms associated) in 11 patients (4.9 percent), and 5 (2.2 percent) had syndromes with related eye problems.
All participants were offered genetic testing for mutations in GJB2. Of the 144 patients who underwent this screening, 27 (18.8 percent) had two mutated copies of the GJB2 gene, and one (3.7 percent) of those had ophthalmologic abnormalities. This compares with none of the 11 patients with a single copy of the mutated gene and 22 of 106 patients (20.8 percent) with no mutations. "This is consistent with the impression that GJB2 mutations result in sensorineural hearing loss but not in additional anomalies or syndromes," the authors write.
"A multidisciplinary approach is important in the evaluation and treatment of children with sensorineural hearing loss to ensure that their medical, education and social needs are met," the authors conclude. "Ophthalmologic evaluation can be beneficial for patients by allowing ophthalmologists to diagnose (and possibly treat) co-existing disorders that affect vision and by helping otolaryngologists to determine the cause of sensorineural hearing loss."
(Arch Otolaryngol Head Neck Surg. 2009;135[2]:119-123. 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, February 16, 2009
Media Advisory: To contact corresponding author Jeong-Whun Kim, M.D., Ph.D., e-mail kimemail{at}snubh.org.
Video Imaging Provides Dynamic View of Airway Obstruction in Those With Sleep Breathing Disorder
CHICAGO—A video imaging technique demonstrates that the soft palate, the tissue at the back of the roof of the mouth, is more elongated and angled in patients with obstructive sleep apnea both when they sleep and when they are awake, according to a report in the February issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.
"Obstructive sleep apnea is a common form of sleep-disordered breathing characterized by repetitive episodes of partial or complete upper airway obstruction," the authors write as background information in the article. The condition usually causes breaks in sleeping, reduced blood oxygen levels and daytime sleepiness, and may contribute to cognitive (thinking, learning and memory) difficulties, psychosocial impairments, trouble driving, heart disease and death.
"The identification of the obstruction site of upper airway in patients with obstructive sleep apnea is essential in choosing the appropriate treatment, especially surgical intervention," the authors write. A variety of methods, including computed tomographic (CT) scanning or magnetic resonance imaging, have been used and previous studies conducted to identify changes in the upper airway of patients with this condition. However, most of the research has been performed when patients were awake or using techniques that produce static, non-moving images.
Chul Hee Lee, M.D., Ph.D., and colleagues at the Seoul National University College of Medicine, Seongnam, South Korea, used sleep videofluoroscopy—a method combining X-ray images with video recording to enable visualization of airway changes—to evaluate 63 consecutive patients. Of these, 53 were classified as having obstructive sleep apnea and 10 were diagnosed as "simple snorers." Participants underwent polysomnography at night and then sleep videofluoroscopy before and after sleep was induced by intravenous administration of the medication midazolam. Respiratory events lasting 15 seconds in which blood oxygen levels did not decrease (referred to as normoxygenation events), as well as any drop in blood oxygen levels of 4 percent or more (called desaturation sleep events), were recorded.
Desaturation sleep events were detected in all of the patients with obstructive sleep apnea but were not observed in simple snorers. When the patients were awake and breathing in, the length and angle of the soft palate increased in patients with obstructive sleep apnea but not in simple snorers; the soft palate also changed length and angle during desaturation sleep events. The sites of airway obstruction could be identified with the sleep videofluoroscopy during desaturation sleep events—the most common obstruction was mixed (soft palate plus tongue base, 43.5 percent) followed by soft palate (34 percent) and tongue base alone (22.5 percent).
"Sleep videofluoroscopy quantitatively showed that the soft palate was considerably elongated and angulated in patients with obstructive sleep apnea even in an awake state," the authors write. "It is an easy way to measure the soft palate changes and may be a useful technique to differentiate obstructive sleep apnea from simple snoring with short examination time."
(Arch Otolaryngol Head Neck Surg. 2009;135[2]:168-172. 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, February 16, 2009
Media Advisory: To contact Jeffrey H. Silber, M.D., Ph.D., call John Ascenzi at 267-426-6055 or e-mail Ascenzi{at}email.chop.edu.
Survival After Surgical Complications Appears Better at Teaching Hospitals for Whites but Not Blacks
CHICAGO—Survival after surgery appears higher at teaching hospitals than at non-teaching hospitals, but this benefit is experienced by white patients and not black patients, according to a report in the February issue of Archives of Surgery, one of the JAMA/Archives journals. While the teaching versus non-teaching setting was not associated with different rates of complications for either white or black patients, whites are less likely to die following complications at teaching hospitals, a survival benefit not seen for black patients.
Outcomes are generally better in hospitals with higher teaching intensity, but prior to this study it was unclear how this benefit was achieved, according to background information in the article. Lower death rates at teaching hospitals might result from preventing complications or preventing death after complications (preventing a failure-to-rescue). "While teaching hospitals are generally larger and have more advanced technology, greater volume and better nurse staffing (attributes that may aid in both preventing complications and successfully treating complications), it is by no means clear whether all patients benefit equally from these attributes," the authors write.
Jeffrey H. Silber, M.D., Ph.D., and colleagues from the Center for Outcomes Research at The Children's Hospital of Philadelphia and the University of Pennsylvania, analyzed Medicare claims from 4,658,954 patients ages 65 to 90 who underwent general, orthopedic or vascular surgery at 3,270 acute care hospitals in the United States between 2000 and 2005. They compared rates of death within 30 days, in-hospital complications and the probability of death following complications between hospitals based on teaching intensity (defined as the number of resident physicians per hospital bed). Among all hospitals and all surgical procedures combined, the overall 30-day mortality rate was 4.23 percent, complication rate was 43.39 percent and rate of death occurring after complications was 9.75 percent.
"Combining all surgeries, compared with non-teaching hospitals, patients at very major teaching hospitals demonstrated a 15 percent lower odds of death, no difference in complications and a 15 percent lower odds of death after complications (failure to rescue)," the authors write. The associations were adjusted for patient illness on admission and did not change even when the researchers considered income, suggesting that the differences in death after complications is not due to unequal access to teaching hospitals between patients in different economic classes.
However, the survival benefits associated with teaching intensive hospitals were not experienced by black patients, who had similar odds of death, complication and failure-to-rescue at teaching and non-teaching hospitals. Furthermore, such differences were apparent even when analyses compared white and black patients inside the same hospital. There are several possible reasons for this disparity, the authors note.
One previous study reported black patients experienced longer delays before beginning defibrillation than white patients, suggesting potential differences in levels of monitoring. "Unintentional differences in communication might lead to less appropriate or less accurate monitoring of black patients or less involvement in their care by personnel who could make a difference in reducing failure to rescue," the authors write. There could also be varying levels of involvement by physicians-in-training in the care of patients in different racial groups, they note.
(Arch Surg. 2009;144[2]:113-120. Available to the media pre-embargo at www.jamamedia.org)
Editor's Note: This work was funded through grants from the National Heart, Lung, and Blood Institute, Department of Veterans Affairs and National Science Foundation. 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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