A team of researchers led by a member of the University of Colorado School of Medicine faculty at the Anschutz Medical Campus examined post-advisory financial relationships between U.S. physicians who advised FDA committees during dermatological drug approval processes. Critics of these industry-physician relationships claim these types of payments could incentivize advisors to alter their voting habits.
The findings are published in a research letter in the Journal of the American Academy of Dermatology.
“It’s known from previous studies that financial payments to FDA advisors can take place after a drug is approved but this is the first time we’ve researched and seen that this trend spans to the dermatology field,” said Robert Dellavalle, MD, PhD, professor of dermatology and public health at the University of Colorado School of Medicine.
Dellavalle adds, “It’s hard to control post-advisory financial relationships since it’s not on the record going into the committee and top doctors can be paid as ongoing academic advisors for a variety of reasons. Regardless, financial conflicts of interest in medical research are important to discuss and monitor.”
Physician advisors serve as external experts in determining whether a new medical therapy is fit for the U.S. market. Of the advisors analyzed, 54 percent received at least one payment from pharmaceutical companies. Twenty-seven percent accepted more than $1,000, 15 percent accepted more than $50,000 and nine percent took more than a $100,000. The advisors received a mean of more than $47,000. For the majority of the drugs examined, payments from competitors outnumbered payments from manufacturers.
The study analyzed Open Payment data, a national transparency program that collects and publishes information about financial relationships between the health care industry (i.e., drug and device companies) and providers (i.e., physicians and teaching hospitals). The study focused on payments made by U.S. physicians who advised FDA committees during the approval of ten dermatologic therapies.
The Cochrane US Network, made up of some of the country’s leading institutions in the research and practice of evidence-based medicine, announced Tuesday the opening of 11 new affiliates across the country including one at the University of Colorado Anschutz Medical Campus.
These new affiliates will join Cochrane’s 70 other groups around the world to promote evidence-informed decision making in health care by supporting and training systematic review authors and users of Cochrane Reviews, as well as working with clinicians, professional associations, policymakers, patients, health care provider organizations and the media to encourage the dissemination and use of Cochrane evidence.
“Cochrane is a leading evidence-based medicine organization, so it’s a very big deal to be a site that is tied to that effort,” said Robert Dellavalle, MD, PhD, MSPH, a professor of dermatology at the University of Colorado School of Medicine, who will lead the CU Anschutz affiliate. “Cochrane is known for having some of the best methodology for doing systematic review of evidence and they are highly cited in the field.”
The Cochrane US Network is made up of the existing Cochrane US West Associate Center based at Oregon Health & Science University; three Cochrane Review Groups producing systematic reviews in neonatal health, fertility regulation and urological conditions; three US satellites of Cochrane Review Groups focusing on eyes and vision, pregnancy and childbirth and musculoskeletal disease; one field specializing in complementary medicine. The 11 new affiliate institutions include:
American College of Physicians
Central Michigan University
Mayo Clinic Evidence-based Practice Center
Penn Medicine Center for Evidence-based Practice
RTI International – University of North Carolina Evidence-based Practice Center
Texas Christian University
University of Chicago Medicine
University of Colorado Anschutz Medical Campus
University of Maryland School of Medicine
Mark Wilson, Cochrane CEO, said: “I am delighted to see such a prestigious and committed group of US institutions and leaders in evidence-informed health care join Cochrane’s global family of collaborators.”
“Many of these researchers and clinicians are leaders in the field, and I am excited by the expertise, innovation and knowledge they will bring to our mission of delivering trusted evidence into health policy and clinical decision-making,” Wilson said. “The US health system is the largest and most sophisticated in the world, yet suffers from huge inequalities in health outcomes and tremendous wastefulness.”
Wilson believes a vibrant Cochrane Network promoting greater use of evidence showing what health interventions work and what don’t can make a real difference.
“I hope that this new – already extensive – network will grow further and welcome many more partners in the years to come,” he said.
These new Cochrane affiliates each have their own specific areas of expertise and focus. Collectively, the Network will focus on producing high quality evidence on priority topics for the US; providing training to systematic review authors and health care practitioners, policymakers and others in the interpretation of Cochrane Reviews. It will also raise the general awareness around Cochrane evidence to make well-informed health and health care decisions. The new Network will build on the work of the former US Cochrane Center based at Johns Hopkins University.
“The establishment of the US Network is an important development for Cochrane as well as the health care community in the U.S.,” said Marguerite Koster, co-chair of the Cochrane Governing Board. “Coordination and collaboration are core values of the Network because we strongly believe we can add value by working together as a consortium. I very much look forward to the start of the network and to seeing it develop and grow as a platform for anyone interested in evidence-informed health and health care in the US.”
A formal launch of the new ‘Cochrane US Network’ was held today in Washington DC. During the launch meeting Cochrane CEO, Mark Wilson, and Governing Board co-chair, Marguerite Koster, introduced the US Network. Additionally, representatives from the Network will introduce their institutions and planned work, and speak to the value of being part of the Network.
The Cochrane US Network is part of Cochrane, a global independent network of researchers, professionals, patients, careers and people interested in health. Cochrane produces reviews which study all of the best available evidence generated through research and make it easier to inform decisions about health. Cochrane is a not-for profit organization with over 65,000 members and supporters from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Cochrane’s work is recognized as representing an international gold standard for high quality, trusted information.
A group of medical students recruited to improve Wikipedia articles on skin-related diseases, saw millions more views of those stories following their editing, highlighting the value of expert input on the popular web encyclopedia.
“We tried to make the articles more readable, while adding more relevant information,” said Olivia Hutton, BS, a medical student at the University of Colorado School of Medicine who led the project. “The articles we edited have been viewed 10 million times since adding the new information.”
The research letter was published online March 28 in the Journal of the American Academy of Dermatology.
Medical stories on Wikipedia receive 10 million views daily and the top 500 skin-related articles saw over 16 million views during August 2018 alone.
But in an effort to make those articles more complete and accurate, an editing partnership was set up between the evidence-based medicine organization Cochrane and Wikipedia in 2014. Cochrane Review Groups work with Wikipedia to recruit and train editors to share high-quality Cochrane Review evidence in Wikipedia stories.
In this case, five students were trained to beef up the articles on skin-diseases. They learned Wikipedia editing, were mentored by an experienced Wikipedia medical editor and were given a list of articles to improve.
The project was supervised by Robert Dellavalle, MD, PhD, MSPH, professor of dermatology at the CU School of Medicine. According to Hutton, the trainees improved 40 skin-specific articles on Wikipedia. They did this by adding paraphrased conclusions and background information from 60 Cochrane Reviews.
The 40 edited stories won millions more views. The top five most viewed articles dealt with psoriasis, leprosy, cellulitis, melanoma and molluscum contagiosum.
“Criticisms of Wikipedia include concerns over the quality of shared content,” Hutton said. “It is important to ensure that Wikipedia’s content is evidence-based, unbiased and up-to-date. We have shown that a small Wikipedia editing initiative has the potential to share evidence-based information with many people.”
Dellavalle, who is also a joint-coordinating editor of Cochrane Skin, said the students’ work with Wikipedia in this regard “is the most expansive provision of public health dermatology information in the world.”
The next step, he said, is to recruit more trainees, improve skin-related Wikipedia content in other languages and make further improvements in articles to increase accuracy and understandability.
The article co-authors include Jennifer E. Dawson, PhD; Kachiu C. Lee, MPH; Peter R. Shumaker, MD; Elizabeth Doney, MSc; Robert P. Dellavalle, MD, PhD, MSPH.
The results were published on Feb. 21, 2018 in Nature Communications.
The team is reporting a clinically safe approach that consistently reprograms healthy and disease-associated patient’s skin cells into induced pluripotent stem cells (iPSCs) with an unprecedented efficiency.
Since its initial discovery in 2006 by Shinya Yamanaka, MD, PhD, iPSC reprogramming technology has created considerable interest in the field of regenerative medicine for its potential of providing an unlimited source of patient-specific cells suitable for transplantation. This technology involves the reprograming of adult skin cells taken from a donor into immature embryonic stem cell-like iPSCs. These iPSCs can be grown outside the body, genetically manipulated, converted into a variety of adult cell types and then either transplanted back to the same patient as an autograft or used as a platform for drug screening and research.
Despite significant advances, current methods for reprogramming adult cells into iPSCs are extremely inefficient and inconsistent, with less than 1 out of every 500-1000 adult human cells becoming iPSCs. The low efficiency of these protocols, coupled with the length of time in culture, increase the chances of accumulating harmful mutations in iPSCs, thus compromising the safety of this technology for clinical applications.
To address the issue of low reprogramming efficiency, the team from the University of Colorado Anschutz Medical Campus optimized the cellular delivery of modified mRNAs, encoding several reprogramming factors in combination with microRNAs, and improved cell culturing conditions to enhance the growth of cells undergoing conversion into iPSCs.
“Many groups had previously attempted to improve reprogramming efficiency by identifying novel modulators of the process,” said Ganna Bilousova, PhD, an assistant professor of dermatology and one of the study’s lead scientists. “Instead of looking for new reprogramming enhancers, we took advantage of the versatility of RNA molecules to control the precise levels of reprogramming factors and microRNAs in cells during their conversion into iPSCs. We were surprised at how simple manipulations of the timing and dosing of the RNA molecules could affect the efficiency of reprogramming.”
The researchers showed that the fine-tuning of RNA delivery and cell culturing conditions dramatically enhanced the efficiency of reprogramming and improved the consistency of the process for disease-associated skin cells.
“Initiating reprogramming at a reduced cell density was critical for improving reprogramming efficiency in our study,” said Igor Kogut, PhD, an assistant professor of dermatology at the Gates Center. Kogut is also one of the paper’s lead authors. “There is a direct correlation between the rate of cell division and the efficiency of reprogramming. Our optimal, combinatorial RNA delivery regimen, which reduced the toxicity of the protocol, made it possible to initiate the process at a reduced cell density, down to individually-plated single cells.”
The goal now is to move the technology from the laboratory into clinical trials. Gates Center Director Dennis Roop, PhD, who is also one of the lead authors on the paper, recognizes the magnitude of the team’s work. He believes it holds great potential for the development of new corrective stem cell-based therapies for currently incurable diseases, such as Epidermolysis Bullosa (EB). Roop has had a long-standing interest in finding a permanent cure for EB, a group of inherited skin diseases that results in severe blistering and scarring. EB affects thousands of people across the United States and worldwide, and is characterized by chronic skin wounds similar in property to thermal burns, and indistinguishable from burns induced by chemical agents such as mustard gas.
“There are no effective therapies for EB, and iPSC technology provides an opportunity to develop a permanent corrective stem cell-based therapy for these severe skin-blistering diseases,” said Roop. “Our breakthrough in developing a highly-efficient reprogramming method, that avoids the use of viral vectors, may allow us to get FDA approval for one of the first iPSC-based clinical trials in the U.S..”
To accelerate getting iPSC-based therapies for EB into the clinic, the CU Anschutz team has established a consortium comprised of the University of Colorado, Stanford University (Anthony Oro, MD, PhD) and Columbia University (Angela Christiano, PhD).
The “EB iPS Cell Consortium” was initially supported by the EB Research Partnership (EBRP), the EB Medical Research Foundation, and the SOHANA Research Fund. More recently, the Consortium has received funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases through the 21st Century Cures Act for the Regenerative Medicine Innovation Project, and the California Institute for Regenerative Medicine’s Partnering Opportunity for Translational Research Projects. The research teams at both Stanford and Columbia have adopted the University of Colorado’s reprogramming technology as the method of choice for generating patient-specific iPSCs for future clinical trials, and thus are setting the standards for future iPSC-based therapies for other diseases.
Prior to receiving the above sources of funding for the Consortium, this study was supported by additional funding from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Department of Defense, the Foundation for Ichthyosis & Related Skin Types, the Dystrophic Epidermolysis Bullosa Research Association (DEBRA) International, The King Baudouin Foundation’s Vlinderkindje Fund, the Linda Crnic Institute for Down Syndrome, the Gates Frontiers Fund and private donors.
Guest contributor: This article was contributed by Jill Cowperthwaite, Gates Center for Regenerative Medicine.
The new study, published online recently in the Journal of the American Academy of Dermatology, summarizes the current literature on the subject and concludes that pharmaceuticals containing cannabinoids may be effective against eczema, psoriasis, atopic and contact dermatitis.
Currently, 28 states allow comprehensive medical cannabis programs with close to 1 in 10 adult cannabis users in the U.S. utilizing the drug for medical reasons. As researchers examine the drug for use in treating nausea, chronic pain and anorexia, more and more dermatologists are looking into its ability to fight a range of skin disease.
“Perhaps the most promising role for cannabinoids is in the treatment of itch,” said the study’s senior author Dr. Robert Dellavalle, MD, associate professor of dermatology at the University of Colorado School of Medicine.
He noted that in one study, eight of 21 patients who applied a cannabinoid cream twice a day for three weeks completely eliminated severe itching or pruritus. The drug may have reduced the dry skin that gave rise to the itch.
Dellavalle believes the primary driver in these cannabinoid treatments could be their anti-inflammatory properties. In the studies he and his fellow researchers reviewed, they found that THC (tetrahydrocannabinol) the active ingredient in marijuana, reduced swelling and inflammation in mice.
At the same time, mice with melanoma saw significant inhibition of tumor growth when injected with THC.
“These are topical cannabinoid drugs with little or no psychotropic effect that can be used for skin disease,” Dellavalle said.
Still, he cautioned that most of these studies are based on laboratory models and large-scale clinical trials have not been performed. That may change as more and more states legalize cannabis.
Dellavalle said for those who have used other medications for itch and skin disease without success, trying a cannabinoid is a viable option especially if it has no psychotropic effect. He did not recommend such medications for cancer based on current evidence.
“These diseases cause a lot of problems for people and have a direct impact on their quality of life,” he said. “The treatments are currently being bought over the internet and we need to educate dermatologists and patients about the potential uses of them.”
The other authors of the study include Jessica S. Mounessa, BS, Julia A. Siegel, BA and Cory A. Dunnick, MD.
The line of physicians in the Kenagy-Vance family stretches across states, continents and generations. For centuries, these medical men have guided the health of communities from Switzerland to Pennsylvania to Idaho and beyond.
And most of their skills were acquired in the same place – the University of Colorado School of Medicine (SOM). Four generations of the family received their MDs here. Dr. John Brough (JB) Kenagy started it all when he graduated from the SOM – located in Boulder then – in 1906.
The family’s next two physicians – Drs. Fayre H. Kenagy (class of 1920) and J. Corwin (Corky) Vance (class of 1971) – attended the medical school in Boulder and then the CU Health Sciences Center in Denver. Corky’s father, Edward Pershing Vance, who married Barbara Eloise Kenagy, took a different path: He enjoyed a successful career in natural resource stewardship in the Pacific Northwest. Dr. Karl Kenagy Vance, son of Corky and Karen Vance, extended the family’s black-and-gold legacy into the 21st century by attending medical school at the CU Anschutz Medical Campus from 2005 to 2009.
Karl applied to about 10 medical schools, but chose CU. “The combination of the high-quality education at the medical school and the lifestyle of being in Colorado factored in,” says the avid cyclist and skier. “Also, it was something I thought would be cool – that I would be the fourth generation of my family to go to the CU School of Medicine.”
The family history of physicians goes back to Bern, Switzerland, where Corky’s sixth great grandfather, Hans Gnage, practiced medicine before fleeing the country over religious persecution of Mennonites. “Family legend has him seeing a patient when the police came to arrest him for draft evasion,” Corky says. “His wife had the policeman sit down to wait for him and offered food and drink, but then sent their son to tell his father to leave the country instead of coming home. His family joined him later.”
Hans arrived in Pennsylvania in 1742 and joined the Amish community, where he resumed work as a physician. It would be several generations later when JB Kenagy, born and raised in a Mennonite community in Ohio, would leave his career as an educator and move from Gunnison to Boulder. After graduating from CU medical school in 1906 he moved to Rupert, Idaho, to practice internal medicine.
His son, Fayre Kenagy, aspired to become a doctor just like his father. He was drafted into World War I but received a deferment to finish his medical degree.
Keeping the CU tradition going
It was Fayre who delivered J. Corwin Vance in August 1945, starting a lifelong bond with the boy who went by the nickname Corky. “I was in awe of my grandfather and wanted to follow in his footsteps. I therefore also attended the CU medical school,” Corky says. “When Karl was born, we named him Karl Kenagy Vance, after his grandfather. He later decided to attend the CU medical school as well, having heard how great it was.”
The elder Dr. Vance is now retired, but Karl worked with his father during the final year of his practice in Minneapolis. Karl now works with several of Corky’s longtime staff members, though in a different dermatology practice. The Twin Cities are a fitting home for the Vances as twin interests abound in father and son, including a shared love of fine food and wine. When they aren’t pursuing culinary interests, you can find Corky and Karl on their bicycles or in planes traveling the world. Sometimes they’re globetrotting and cycling – as they did on a recent family trip to Italy.
Incidentally, they both met their wives while attending the CU medical school. Corky met Karen while she was a lab technician, and Karl hit it off with Pamela while out on the town with classmates.
Just as Corky was inspired to pursue medicine by his grandfather, Karl looked up to his father, who became the first dermatologist in the Twin Cities to perform Mohs surgery – a micrographic procedure that removes skin cancers. “He found it rewarding. Growing up around medicine, you get an understanding of the process, the responsibilities and the ups and downs of it,” Karl says. “Mostly, it’s a fulfilling career because it’s a daily opportunity to help people.”
Camaraderie with CU classmates
Excellence in clinical care
“If you want to get clinically grounded, the CU School of Medicine is as good as any,” says Dr. Corky Vance, who attended the SOM from 1967 to 1971. “I got to see acute and emergency care at Denver General, and at University Hospital I got to see the rare cases you heard about from your professors. We also went out to the Fitzsimons Army Hospital (as it was known then) and saw cases and procedures that you were going to see in your own practice. There was a real advantage to having that much exposure to clinical practice.”
The retired physician says the SOM is even better since moving to the CU Anschutz Medical Campus. “Having everything together – with the hospitals on campus, as well as the VA – it really makes it even easier to get clinical exposure.”
Unlike the camaraderie he enjoyed at CU Anschutz, Karl struggled to connect with his pre-med classmates as an undergraduate at Stanford University. But he excelled in chemical engineering, and it wasn’t long before he connected that discipline to his burgeoning interest in wine. After graduating from Stanford, he became an assistant wine maker in Northern California and Australia. A few years later, however, he realized that winemaking couldn’t quite match the fulfillment of medicine.
At CU Anschutz, Karl loved his classmates – “It was hard to find people who weren’t into skiing and biking,” he says. And he was influenced by Dr. J. Ramsey Mellette, the faculty member who trained him on Mohs surgery. Back in the 1970s when Corky first performed Mohs, it was a new and innovative procedure. “Now, this procedure is pretty widespread,” Karl says. “I like it because of the precision in which we take the cancer out, and I enjoy the creativity involved in the reconstruction (of the tissue).”
Mohs is usually performed on a patient’s face, so the reconstruction of the skin requires utmost precision to minimize scarring.
Finding a mentor in the SOM
Corky was inspired to pursue dermatology by Dr. Robert Goltz, who in the late 1960s served as head of the Dermatology Department in the medical school. Corky so enjoyed Goltz’s teaching that he took the professor’s early-morning class on public health. “Dr. Goltz noticed that I was a hard worker, that I liked dermatology and was good at it,” Corky says. “I was good at visual learning, and that’s why dermatology appealed to me. You have to be able to memorize what rashes and other conditions on the skin look like.”
Goltz proved to be the catalyst for Corky’s career in Minnesota. Goltz, who had just accepted a job as chair of dermatology at the University of Minnesota, suggested Corky pursue his residency in the Land of Lakes.
Now, as Corky and Karen settle into retirement, they watch their progeny carry on the Kenagy-Vance caregiver tradition. Karl has established his own thriving practice in Minneapolis, while his sister Chardonnay, who attended medical school at Wake Forest University, is a family practice doctor. The life in medicine has made for a full, satisfying ride for the elder Vances – and a lasting family legacy that’s anchored in CU’s SOM.
“The most important thing is your job,” Corky says. “If you have a miserable job, you’ll be miserable wherever you are. If you have a rewarding job – as we are lucky enough to have – you’ll be happy.”
“A growing national body of evidence links indoor tanning with other risky health-related behavior among adolescents,” said study author Robert Dellavalle, MD, associate professor of dermatology at the University of Colorado School of Medicine.
The study, which appears online today in JAMA Dermatology, says the motivation behind indoor tanning offers clues to why it is also tied to other risky behaviors.
Dr. Robert Dellavalle, associate professor of dermatology at the University of Colorado School of Medicine.
Dellavalle, who also practices at the Denver Veterans Affairs Medical Center, said people tan for both psychological and physiological reasons.
“For example, indoor tanning and use of steroids may both stem from the motivation to enhance one’s appearance,” he said. “Data also implicate addictive physiological pathways in indoor tanning that may be similar to those of substance abuse.”
Research has shown that indoor tanning can release endorphins in users that can be addictive.
The study used the Healthy Kids Colorado Survey of health data from Colorado public schools. A total of 12,144 students answered the question, “During the last 12 months, how many times did you use an indoor tanning device such as a sunlamp, sunbed or tanning booth?”
The analysis showed females were almost twice as likely to engage in indoor tanning as males. Researchers also found that any lifetime use of steroids was the variable most strongly associated with indoor tanning, especially among males.
“Any alcohol consumption within the prior 30 days and marijuana use were also associated with indoor tanning, as was lifetime use of select illicit drugs,” the study said.
Dellavalle said indoor tanning is potentially dangerous. The World Health Organization has deemed UV radiation as a group 1 carcinogen putting users at a higher risk of melanoma, basal cell carcinoma and squamous cell carcinoma.
“Risky behaviors tend to go together,” Dellavalle said. “So someone who does indoor tanning may more easily move on to other risky behaviors like illicit drug use.”
The researchers urged physicians treating those who use indoor tanning to consider assessing them for steroid use, especially if the patient is an adolescent male. They also said parents should get involved.
“If you are a parent and your child is tanning,” Dellavalle said, “you should also check for drug abuse.”
The study co-authors include Myra Sendelweck, ME, of CU Anschutz, Eric Bell, PhD, Amy Marie Anderson, MPH, Kurt Ashack, BA, Talia Pindyck, MD, Cate Townley, MURP, MUD.
The first national survey of skin infections among high school athletes has found that wrestlers have the highest number of infections, with football players coming in a distant second, according to researchers at the University of Colorado Anschutz Medical Campus.
The study, published in the February edition of the Journal of the American Academy of Dermatology, examined data from a large national sample of U.S. high schools over five years and found that 73.6 percent of skin infections occurred during wrestling followed by football with 17.9 percent. The head and neck were the most frequent site of infection.
“Given the nature of the sport, it’s not surprising that wrestlers suffer the most skin infections,” said senior author Robert Dellavalle, MD, associate professor of dermatology at the University of Colorado School of Medicine. “Most of the infections were bacterial and fungal.”
Most athletes were able to return to play within three to six days but some of the infections were more serious.
“While most skin infections require a week recovery on average, others may have more serious eye and neurological involvement from a primary Herpes Simplex Virus,” said study co-first author Kurt Ashak, a fourth year medical student at Michigan State University who helped conduct the research during a recent dermatology rotation at CU Anschutz.
They looked at 22 high school sports and found 474 skin infections reported during 20,858,781 ‘athlete exposures’ (AE) or one athlete participating in one practice, competition, or performance. The rate of skin infections in wrestling was 28.56 per 100,000 AE while football rates were 2.32 per 100,000. Other sports had rates of skin infections less than 1.00 per 100,000 AE with eight reporting none at all.
Some 60.6 percent of skin infections were bacterial followed by tinea (ringworm) at 28.4 percent. The study showed herpetic lesions like cold sores and fever blisters represented 5.2 percent of infections while 3.2 percent were miscellaneous infections.
“A number of best practices are available to prevent sports-related skin infections,” said study co-first author Kyle Burton, a fourth-year medical student at the University of Central Florida, who also did the research during a dermatology research rotation at CU Anschutz. “For example, the Centers for Disease Control and Prevention currently recommends that athletes take showers directly after each competition.”
Burton said if showering directly after each competition and practice is not possible, studies have shown that skin infections also drop dramatically when athletes use soap and water skin wipes. A recommendation from the National Federation of State High School Athletic Associations calls for referees to perform skin checks before each wrestling match in an attempt to prevent athletes from spreading infections.
Dr. Dellavalle noted that most schools wipe down wrestling mats before and after competitions but given that most infections occur on the head and face, they should be more vigilant about headgear.
“Wrestlers are not rubbing their heads and faces on the mats,” he said. “The problem may be not keeping headgear properly cleaned before each match.”
The study co-authors include Dawn Comstock, PhD and Dustin Currie, MPH, both of the Colorado School of Public Health at CU Anschutz. Teresa R. Johnson, MS, PhD, of the University of Central Florida College of Medicine in Orlando is also co-author.