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July 7, 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
JAMA NEWS RELEASES
(Embargoed for Release: 3 p.m. CT Tuesday, July 7, 2009)
JAMA REPORT (VIDEO SCRIPT)
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. TV Note: PLEASE NOTE, FEED TIMES ARE NOW 15 MINUTES. This week's JAMA Report video is on how higher levels of a protein produced by fat cells is linked with a lower risk of diabetes. The report will be fed Tuesday, July 7, from 9:00 - 9:15 a.m. ET and 2:00 - 2:15 p.m. ET, on Galaxy 28 (C-Band), Transponder 19, downlink frequency: 4080 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA. The JAMA Report video is also now available on Pathfire every Tuesday. Please look for the JAMA Report "channel". 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), Tuesday, July 7, 2009
Newer, Minimally Invasive Surgical Procedure For Treatment of Sciatica Does Not Result In Better Outcomes
CHICAGO—A comparison of surgical treatments for sciatica finds that the minimally invasive procedure known as tubular diskectomy does not provide a significant difference in improvement of functional disability compared to the more common surgery, conventional microdiskectomy, according to a study in the July 8 issue of JAMA. Sciatica or lumbosacral radicular syndrome affects millions of individuals worldwide and is typically caused by disk herniation. Surgery is offered to patients with persistent pain that is not responding to conservative treatment, with the common surgical procedure being microdiskectomy (removal of injured disk tissue and pieces). The minimally invasive technique of transmuscular tubular diskectomy was introduced in 1997. "The rationale behind replacing the conventional subperiosteal muscle dissection by the muscle-splitting transmuscular approach of tubular diskectomy is less tissue damage, resulting in a faster rate of recovery but with similar long-term outcomes. Patients are expected to have reduced postoperative back pain, thus allowing quicker mobilization and contributing to shorter hospitalization and faster resumption of work and daily activities," the authors write. Although this procedure was introduced to increase the rate of recovery, there is a lack of evidence, according to background information in the article. Mark P. Arts, M.D., of the Medical Center Haaglanden, the Hague, the Netherlands, and colleagues conducted a multicenter trial to determine the outcomes and time to recovery in patients with lumbar disk herniation treated with tubular diskectomy or conventional microdiskectomy. The study included 328 patients age 18 to 70 years who had persistent leg pain (greater than 8 weeks) due to lumbar disk herniations. Patients were randomized to either tubular diskectomy (n = 167) or conventional microdiskectomy (n = 161). Functional ability, pain and self-report of recovery were measured via a questionnaire or surveys. The researchers found: "The expected treatment benefit of a faster rate of recovery from sciatica after tubular diskectomy could not be reproduced by this double-blind study. This study revealed evidence that the rates of recovery for the minimally invasive tubular diskectomy and conventional microdiskectomy were similar. In contrast, the overall differences in pain intensity and recovery rates favored the conventional microdiskectomy approach." At 1 year, 107 of 156 patients (69 percent) assigned to tubular diskectomy reported a good recovery vs. 120 of 151 patients (79 percent) assigned to conventional microdiskectomy.
"Although the minimally invasive technique of tubular diskectomy seemed to be an attractive surgical method for treating sciatica, our data do not support a higher rate of recovery when compared with conventional microdiskectomy. On the contrary, patients who underwent tubular diskectomy fared worse with regard to leg and back pain and fewer patients reported complete recovery at 1 year," the authors conclude.
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), Tuesday, July 7, 2009
Reduced-Dose Schedule for Pneumococcal Vaccine in Infants Shows Effectiveness
CHICAGO—Infants who received two or three primary doses of the 7-valent pneumococcal conjugate vaccine (PCV-7) both had a decreased rate of carrying pneumococcal microorganisms that can cause pneumonia and other infections, compared to infants who were not vaccinated, according to a study in the July 8 issue of JAMA. Crowded infant vaccine schedules and less favorable cost-effectiveness calculations have prompted exploration of reduced-dose vaccine schedules other than the currently recommended 3 + 1-dose schedule of PCV-7, which consists of 3 primary doses before age 6 months followed up by a booster vaccination in the second year of life, according to background information in the article. Difficulty in implementing the 3 + 1-dose schedule in developing countries is another reason for exploring reduced schedules. The effects of reduced-dose schedules of PCV-7 on pneumococcal carriage in children are largely unknown. Elske J. M. van Gils, M.D., of the University Medical Center Utrecht, the Netherlands, and colleagues examined the effects of a 2-dose and 2 + 1-dose PCV-7 schedule on nasopharyngeal (upper part of the throat behind the nose) pneumococcal carriage in young children. The randomized trial included 1,003 healthy newborns and 1 of their parents in a general community in the Netherlands, with follow-up to age 24 months. Infants were randomly assigned to receive 2 doses of PCV-7 at 2 and 4 months; 2 + 1 doses of PCV-7 at 2, 4, and 11 months; or no dosage (control group). No significant differences in vaccine serotype (a strain of microorganisms having a set of antigens in common), nonvaccine serotype, and overall pneumococcal carriage were observed at 6 months in both vaccine groups compared with the control group. At 12 months, vaccine serotype carriage rates were significantly lower in both vaccine groups compared with the control group, with 25 percent in the 2-dose schedule group, 20 percent in the 2 + 1-dose schedule group, and 38 percent in the control group. A further decrease of vaccine serotype carriage was found at 18 months after 2 + 1-dose schedule and at 24 months after 2 primary doses compared with the control group. In analysis comparing the 2-dose and 2 + 1-dose schedules, the researchers observed a significant difference in vaccine serotype carriage at 18 months with 24 percent vaccine serotype carriage in the 2-dose schedule group compared with 16 percent in the 2 + 1-dose schedule group. At 24 months, the estimates for vaccine serotype carriage in both vaccine groups were at the same level with 15 percent in the 2-dose schedule group and 14 percent in the 2 + 1-dose schedule group, compared with 36 percent in the control group.
"In conclusion, both 2-dose and 2 + 1-dose schedules of PCV-7 significantly reduce vaccine serotype pneumococcal carriage in children. This study supports future implementation of reduced-dose PCV-7 schedules," the authors write.
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), Tuesday, July 7, 2009
Higher Levels of a Certain Protein Associated With Lower Risk of Type 2 Diabetes
CHICAGO—Persons with higher levels of adiponectin, a protein that is produced by fat cells and that has anti-inflammatory and insulin-sensitizing properties, have an associated lower risk of type 2 diabetes, according to an analysis of previous studies, reported in the July 8 issue of JAMA. Some studies have suggested several mechanisms through which adiponectin may decrease the risk of type 2 diabetes, although the strength and consistency of the relation between plasma adiponectin and risk of type 2 diabetes has been unclear, according to background information in the article. Shanshan Li, M.D., M.Sc., of the Harvard School of Public Health, Boston, and colleagues conducted a review and meta-analysis to assess the consistency of the association of adiponectin levels and risk of type 2 diabetes. The researchers identified thirteen studies with a total of 14,598 participants and 2,623 new cases of type 2 diabetes that met criteria for inclusion in the meta-analysis. The authors found that higher adiponectin levels were associated with a lower risk of type 2 diabetes. This inverse association was consistently observed in whites, East Asians, Asian Indians, African Americans and Native Americans. The results did not differ substantially by method of diabetes ascertainment, study size, follow-up duration, body mass index or proportions of men and women. "Although these epidemiologic studies cannot establish causality, the consistency of the association across diverse populations, the dose-response relationship, and the supportive findings in mechanistic studies indicate that adiponectin is a promising target for the reduction of risk of type 2 diabetes," the authors write.
The researchers add that recent studies have shown that adiponectin levels can be increased through pharmaceutical and lifestyle interventions. "In addition, adiponectin levels may be useful for identifying persons likely to benefit most from interventions to treat 'dysfunctional adipose tissue' and its metabolic complications. Future studies should also evaluate whether adiponectin is useful for prediction of type 2 diabetes in addition to established risk factors using statistical techniques appropriate for prognostic analyses."
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.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
HIGH LEVELS OF A FAT-PRODUCED HORMONE LOWERS RISK OF TYPE 2 DIABETES
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