|
|
|
|
|
| ||
|
May 18, 2009JAMA 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 FACIAL PLASTIC SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, May 18, 2009)
ARCHIVES OF DERMATOLOGY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, May 18, 2009)
ARCHIVES OF SURGERY NEWS RELEASES
(Embargoed Until: 3 P.M. (CT), Monday, May 18, 2009)
ARCHIVES OF OTOLARYNGOLOGY—HEAD & NECK SURGERY
(Embargoed Until: 3 P.M. (CT), Monday, May 18, 2009)
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, May 18, 2009
Risk of Facial Fractures in Motor Vehicle Crashes Decreasing
CHICAGO—Facial fractures from motor vehicle crashes appear to be decreasing, most likely due to design improvements in newer vehicles, according to a report in the May/June issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals. Facial trauma is the most common injury among individuals involved in motor vehicle collisions, according to background information in the article. Fractures to the face often occur simultaneously with other injuries, including damage to the eyes and brain. In 2000, the National Highway Traffic Safety Administration estimated that facial injuries cost between $9,000 and $725,000 per injury in lost productivity, medical costs, emergency services and other expenses. Brian T. McMullin, M.D., of the Medical College of Wisconsin, Milwaukee, and colleagues analyzed records from a national database of individuals (drivers and front seat occupants) with facial fractures following motor vehicle crashes. Between 1993 and 2005, 167,391 individuals involved in collisions had one or more facial fractures, 55,150 had skull base fractures (breaks in the bones of the skull) and 196,855 had nasal fractures. Each year during that time period, the incidence of facial fractures decreased. In addition, a decline in the probability of injury was associated with newer car models. "As older cars are scrapped and more vehicles with next-generation safety features enter the vehicle fleet, we would expect decreasing injury probabilities and ultimately overall decreased injury incidence for year-to-year trends," the authors write. Individuals involved in side-impact collisions, in vehicles in which speed increased as a result of collision, who were taller or who collided with a stationary object, light truck, sports utility vehicle or van were significantly more likely to sustain facial fractures. "Occupants who were restrained with seat belts only, as well as those restrained with seat belts and air bags, were significantly less likely to have facial fractures," the authors write. "Air bags alone were not associated with a reduced probability of facial fractures, and there was no difference in injury probability between sexes or based on occupant weight."
"Restraint use continues to be the most significant element for facial and skull base injury prevention, and more research is necessary to elucidate the mechanisms for facial and skull base fractures in side impacts, as well as to determine the effectiveness of side impact supplemental restraint systems," they conclude.
Editor's Note: This study was funded in part by a grant from the Medical College of Wisconsin Injury Research Center. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 18, 2009
Westernization Associated With Potentially Harmful Sun Habits Among Asian Americans
CHICAGO—Asian Americans who have adopted more aspects of Western culture may be more likely to engage in behaviors that increase sun exposure, thereby endangering their skin health, according to a report in the May issue of Archives of Dermatology, one of the JAMA/Archives journals. Skin cancer typically affects individuals of Asian descent at a lower rate than white individuals, but recent data indicates the disease may be increasing in Asian populations, according to background information in the article. "In the medical literature, numerous published studies among Asians report an association between acculturation to a Western diet and increased risk of cardiovascular disease, type 2 diabetes mellitus and breast cancer. The health consequences of adopting a Western lifestyle are not likely to be limited to dietary changes alone," the authors write. "Although it is difficult to directly compare dietary changes and consequent disease with sun exposure patterns and subsequent skin disease, we mention this as an intriguing potential parallel because both involve westernization." Emily Gorell, B.A., and colleagues at the Stanford University School of Medicine, Stanford, Calif., conducted an online survey of Asian Americans living in California from November 2007 to January 2008. Participants provided information regarding the degree to which they had acculturated along with details on sun exposure, protection and skin cancer–related habits. Of the 546 individuals (average age 34) who completed the survey, 57.3 percent identified themselves as being of Chinese or Taiwanese descent, 8.2 percent as Korean, 6 percent as Japanese and 12 percent as mixed Asian descent. Those who were more westernized—defined as those whose families had been in the United States for at least a generation, who were raised mostly or only in the United States rather than in Asia or who rated themselves as more acculturated—more often had attitudes and behaviors promoting sun exposure. For instance, these individuals were more likely to report believing a tan is attractive, having a negative attitude toward sunscreen and getting more sun exposure on the weekends. "Among more westernized Asian Americans, the practice of deliberate sunbathing was widespread," the authors write. A history of laying out in the sun was reported by 60 percent of second-generation or greater Asian Americans (vs. 47 percent of first-generation), 59.1 percent among those raised mostly or exclusively in the United States (vs. 33.7 percent for those raised mostly or exclusively in Asia) and 58 percent of those who rated themselves as bicultural or more westernized (vs. 43.6 percent of those who self-identified as more Asian). "Although it has generally been accepted as conventional wisdom that Asian cultures prize lighter skin tones and that Western cultures value a ‘healthy' tanned appearance, to our knowledge, our study is the first to explore what happens to attitudes and practices of sun exposure when Asians adopt Western culture. Specifically, the adoption of Western culture seems to increase sun exposure, implying negative consequences to skin health," the authors conclude.
"In light of recent evidence pointing to the increasing incidence of skin cancers among Asian populations, as well as delays in diagnosis of skin cancer in part because of a lowered index of suspicion by health care providers and by Asian Americans, dermatologists and other health care providers in the United States should increase their education efforts about sun exposure, sun protection and skin cancer targeted at this growing minority group."
Editor's Note: Dr. Chang is an investigator in clinical trials sponsored by NuSkin International and Spiracur Inc. that are unrelated to this study. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 18, 2009
Web-Based Consultations May Reduce Referrals to Dermatologists
CHICAGO—A Web-based system allowing general practitioners to confer with specialists regarding patients with skin conditions may reduce referrals to dermatologists by approximately 20 percent, according to a report in the May issue of Archives of Dermatology, one of the JAMA/Archives journals. "In Western countries, health services face increasing pressures because of the aging population and patients' increasing demands for evaluation by specialists," the authors write as background information in the article. "The demand results in increased referral to specialists and longer waiting times for appointments. This has led to a debate regarding the appropriateness of referrals and what treatment general practitioners should be able to provide before referral. Improved communication between general practitioners and specialists leads to lower referral rates." Telemedicine using e-mail or Web sites holds promise for enhancing communication, especially in the area of dermatology, which is visual in nature and is the frequent reason for both visits to the general practitioner and referrals. Nina Eminović, Ph.D., of the University of Amsterdam, the Netherlands, and colleagues conducted a randomized controlled trial of teledermatologic consultations involving 85 general practitioners from 35 practices in two regions of the Netherlands. Eighteen of the practices, which included 46 general practitioners, were randomly assigned to participate in the intervention. For each of 312 eligible patients, the clinicians took four digital images of the skin problem and attached them to a form completed on a secure Web site. A dermatologist reviewed the form and provided feedback within 48 hours about further procedures. The other 16 practices, which included 39 general practitioners, referred 293 eligible patients according to their usual practices. All of the patients were seen in the office by one of five study dermatologists after about one month. The dermatologist then rated whether the consultation was preventable, most often because the patient had recovered or the general practitioner could have treated the condition without a specialists' assistance. In-person consultations were determined to be preventable for 39 percent of the patients in the teledermatology group and 18.3 percent of the control patients—a difference of 20.7 percent. At the one-month visit, 20 percent of patients who received teledermatologic consultations had recovered compared with 4.1 percent of control patients. A group of 350 patients (57.8 percent), including 191 (54.6 percent) in the teledermatology group, completed a satisfaction questionnaire following the study. No differences were observed between the two groups in interpersonal aspects or general satisfaction.
"Teledermatologic consultation successfully enables general practitioners to treat patients they would otherwise refer to a dermatologist," the authors conclude. "Further research conducted with more specific patient groups as well as about patient satisfaction should be encouraged."
Editor's Note: This study was supported in part by Senter Novem (Agency of the Dutch Ministry of Economic Affairs) and ZonMw (Dutch Organization for Health Research and Development). KSYOS Health Management Research provided the digital cameras and teleconsultation software. 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. EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 18, 2009
Thyroid and Parathyroid Surgery Outcomes May be Worse in Pregnant Women
CHICAGO—Pregnant women appear to have worse clinical and economic outcomes after thyroid and parathyroid surgery compared with women who are not pregnant, according to a report in the May issue of Archives of Surgery, one of the JAMA/Archives journals. Thyroid and parathyroid surgery are used to treat cancer and other conditions. The incidence of thyroid cancer has increased by almost 250 percent over the last 30 years, increasing from 3.6 to 8.7 cases per 100,000 persons, according to background information in the article. The rate is almost double in pregnant women, with 14.4 cases per 100,000 persons. "Hyperthyroidism [overactive thyroid] has been reported in 0.1 percent to 0.4 percent of pregnancies. Inadequately treated hyperthyroidism during pregnancy poses significant risks to both mother and fetus," the authors write. "Outcomes after thyroid and parathyroid procedures during pregnancy have not been well characterized in the surgical literature." SreyRam Kuy, M.D., of Yale University School of Medicine, New Haven, Conn., and United States Department of Veterans Affairs, Washington, and colleagues compared clinical and economic outcomes of thyroid and parathyroid surgery performed on 201 pregnant women (average age 29) and a group of 31,155 age-matched, non-pregnant women from 1999 to 2005. Fetal, maternal and surgical complications as well as in-hospital death, length of stay and hospital costs were measured. Of the 201 pregnant women, 165 underwent thyroid procedures and 36 underwent parathyroid procedures. "Compared with non-pregnant women, pregnant patients had a higher rate of endocrine [relating to glands that secrete hormones](15.9 percent vs. 8.1 percent) and general complications (11.4 percent vs. 3.6 percent), longer unadjusted lengths of stay (two days vs. one day) and higher unadjusted hospital costs ($6,873 vs. $5,963)," the authors write. "The fetal and maternal complication rates were 5.5 percent and 4.5 percent, respectively," Additionally, pregnant patients had higher surgical complications than non-pregnant patients for benign (27 percent vs. 14 percent) and malignant (21 percent vs. 8 percent) thyroid diseases while undergoing thyroidectomy (the surgical removal of part or all of the thyroid gland). "Differences between pregnant and non-pregnant women in complication rates were most pronounced by diagnosis, race and hospital size," the authors note. When compared to non-pregnant women of the same race, white pregnant patients had double the complication rate (21 percent vs. 10 percent), black pregnant patients had nearly five times the complication rate (48 percent vs. 10 percent) and Hispanic pregnant patients had an almost 3-fold higher complication rate (30 percent vs. 12 percent).
"These data suggest that thyroid and parathyroid surgery during pregnancy should be approached with caution and careful deliberation about whether the risks are outweighed by the benefits," the authors conclude. "Surgeon volume is an important predictor of outcomes, so pregnant women undergoing thyroid and parathyroid procedures should be directed to high-volume surgeons whenever possible. Disparities in outcomes based on race and insurance must be overcome. Optimizing maternal and fetal outcomes requires the collaboration of surgeons, endocrinologists, obstetricians, neonatologists, anesthesiologists, insurers and policy makers."
Editor's Note: The study was supported by the Robert Wood Johnson Foundation and the United States Department of Veterans Affairs. 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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 18, 2009
Study Examines Trends in Gallbladder Cancer Over Four Decades
CHICAGO—Overall prognosis for gallbladder cancer appears to be improving, although many patients still have incurable disease and poor survival rates, according to a report in the May issue of Archives of Surgery, one of the JAMA/Archives journals. An estimated 9,520 new cases of gallbladder or bile duct cancer were diagnosed in the United States in 2008, and approximately 3,340 of these patients will die of their disease, according to background information in the article. The disease affects women more frequently than men and surgical removal of diseased portions of the organ (resection) is the only curative treatment. However, many patients present to the clinician with advanced-stage disease and are not candidates for this procedure. "Gallbladder cancer is characterized by locally aggressive behavior, with early spread to regional lymph nodes and distant dissemination," the authors write. "In addition, it recurs rapidly even after presumed curative resection." Ioannis T. Konstantinidis, M.D., of Massachusetts General Hospital and Harvard Medical School, Boston, and colleagues identified 402 patients with gallbladder cancer at one university-affiliated tertiary care center between 1962 and 2008. Of these, 260 underwent surgical exploration at the same institution and were included in the data analysis. They were diagnosed during three periods: period A (1962 to 1979, 83 patients), period B (1980 to 1997, 105 patients) and period C (1998 to 2008, 72 patients). Overall median (midpoint) survival improved from 3.5 months in period A to 6.5 months in period B and 12 months in period C. "The stage of disease at presentation affected the survival in all time periods (stage I, median survival not reached; stage II, 10.3 months; stage III, 4.7 months and stage IV, four months)," the authors write. "The survival of patients who presented with advanced-stage disease and who underwent palliative [treating symptoms only] procedures remained poor in all periods (A, 1.9 months; B, 3.9 months; and C, 3.6 months)." Of the 260 cancer patients who had surgery to explore the extent of their disease, 151 (58.1 percent) underwent resection. Unresectable disease was found in eight patients and became less common over time (44.4 percent in periods A and B, 17.3 percent in period C). Between January 1994 and March 2008, 6,881 laparoscopic cholecystectomies (procedures to remove gallstones) were performed at the same facility; 17 cases of gallbladder cancer were discovered incidentally during these procedures. "When gallbladder cancer is found incidentally during or after a cholecystectomy, aggressive resection should be performed either during the present operation or during a second operation," the authors write. "In our series, 56 percent of patients who underwent re-exploration [a second surgery] were found to have residual disease. Patients underwent re-exploration at a median of 41 days, similar to other series. Increased T stage at cholecystectomy correlated with a higher frequency of residual disease."
"Patients with gallbladder cancer continue to have a poor prognosis because many of the patients present with advanced disease," the authors write. "Earlier detection coupled with an aggressive surgical approach leads to better outcomes. A better understanding of the molecular pathways contributing to the development of gallbladder cancer is needed to develop improved adjuvant therapies to increase overall survival."
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.
EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, May 18, 2009
Surgery, Oral Devices Associated With Improvement in Sleep Breathing Disorder
CHICAGO—Treatment with surgery or an oral appliance that adjusts the jaw is associated with improvements in obstructive sleep apnea, a condition caused by blocked upper airways in which patients periodically stop breathing during sleep, according to two reports in the May issue of Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals. Sleep apnea is most commonly treated with continuous positive airway pressure (CPAP) therapy, according to background information in one of the articles. Individuals undergoing CPAP therapy wear a mask at night connected to a machine that increases air pressure in the throat, preventing the airway from closing. "Although it is a safe and effective therapy, it has several drawbacks including discomfort or skin irritation from the mask, dry or stuffy nose and eye irritation," the authors write. "Such complications result in compliance rates of between 50 percent and 70 percent, even in patients with successful amelioration of obstructive sleep apnea syndrome symptoms by using CPAP ventilation." "Patients with obstructive sleep apnea who cannot tolerate or refuse CPAP therapy may be considered for surgical treatment," write Neville Patrick Shine, F.R.C.S. (O.R.L.-H.N.S.), of St. Johns Hospital, Edinburgh, Scotland, and Richard Hamilton Lewis, F.R.A.C.S., of Royal Perth Hospital, Perth, Australia. Drs. Shine and Lewis reviewed the medical records of 60 patients (55 men and five women, average age 47.5) undergoing surgery to treat obstructive sleep apnea between 2002 and 2006. The procedure, transpalatal advancement pharyngoplasty, aims to address the airway obstruction and create a larger space in the area behind the roof of the mouth. All participants underwent sleep testing before and after surgery. As measured by the number of sleep disturbances and arterial oxygen saturation (the amount of oxygen in blood flowing through the arteries, which decreases in patients with obstructive sleep apnea), surgery was considered successful in 38 of the 60 patients (63 percent). Sleep apnea was completely cured in 21 patients (35 percent). No associations were found between preoperative characteristics—including demographic, historical and clinical variables such as disease severity or obesity—and surgical outcome, suggesting that it may be difficult to predict which patients will respond well to the procedure. "To our knowledge, this is the largest series reported to date regarding the transpalatal advancement pharyngoplasty procedure," the authors conclude. "It should be considered in patients in whom conservative management has failed and who are willing to undergo surgery to improve the retropalatal airway." In another article, Chul Hee Lee, M.D., and colleagues at Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea, evaluated 50 Korean patients (46 men and four women, average age 50.2) who received an oral device to treat obstructive sleep apnea between 2005 and 2007. The mandibular advancement device prevents airway obstruction by moving the lower jaw forward. Patients underwent sleep testing by polysomnography before and at least three months after receiving the device, completed questionnaires about sleep quality and sleepiness and had several measurements of their tongue and throat areas taken and analyzed. As defined by the number of episodes of shallow or stopped breathing per night, the device was considered successful in 37 of 50 patients (74 percent). This included three of seven patients with mild cases of obstructive sleep apnea (43 percent), 22 of 27 with moderate cases (82 percent) and 12 of 16 with severe cases (75 percent). No differences were seen between patients who did and did not respond successfully to treatment with regards to demographic data or data gathered during sleep testing.
"In conclusion, the mandibular advancement device is a simple, non-invasive, easy-to-manufacture and easy-to-use device and showed good treatment outcome in nocturnal respiratory function and sleep quality in Korean patients with obstructive sleep apnea," the authors write. "Even in patients with severe obstructive sleep apnea, mandibular advancement device application showed a good success rate. Hence, mandibular advancement device application can be used as a good alternative option in patients with obstructive sleep apnea, without patient selection, and could be used in patients with severe obstructive sleep apnea."
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. |
|
|
