Reduced Sodium Intake May Improve Heart Failure Prognosis

MedicalResearch.com Interview with:
Dr. Eloisa Colin-Ramirez, BSc, PhD
and
Justin A. Ezekowitz, MBBCh MSc
Associate Professor, University of Alberta
Co-Director, Canadian VIGOUR Centre
Director, Heart Function Clinic
Cardiologist, Mazankowski Alberta Heart Institute

Medical Research: What is the background for this study? What are the main findings?

Response: The SODIUM-HF study is a randomized control trial on sodium restriction in patients with chronic heart failure (HF). Sodium restriction has been broadly recommended as part of the self-care strategies in heart failure yet is based on little high-quality evidence. This study reports the results of the pilot SODIUM-HF trial in 38 patients with chronic HF. Nineteen patients were prescribed a low sodium containing diet (1500 mg/day) and 19 a moderate sodium containing diet (2300 mg/day). Both interventions were based on a structured and individualized meal plan to achieve the targeted sodium intake, and all patients were followed for 6 months with monthly phone call to reinforce adherence to the diet.

We found a meaningful reduction in sodium intake to less than 1500 mg/day at 6 months in both groups. Additionally, we observed that patients that achieved a sodium intake less than 1500 mg/day at 6 months of follow-up had reduced BNP levels, a biomarker of volume overload and surrogate prognostic marker in heart failure, and increased overall and clinical scores of the Kansas City Cardiomyopathy Questionnaire, compared to those with a sodium intake greater than 1500 mg/day.

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Some Diabetics Do Not Benefit From Exercise

Lauren Marie Sparks, PhD Faculty Scientist at the Translational Research Institute for Metabolism and Diabetes Florida Hospital and the Sanford-Burnham Medical Research Institute Orlando, FLMedicalResearch.com Interview with:
Lauren Marie Sparks, PhD
Faculty Scientist at the Translational Research Institute for Metabolism and Diabetes
Florida Hospital and the Sanford-Burnham Medical Research Institute Orlando, FL

Medical Research: What is the background for this study? What are the main findings?

Dr. Sparks: As a clinical scientist focused on exercise effects on muscle metabolism in diabetes, I have seen first-hand a significant minority of individuals with diabetes not improve their glucose control (HbA1c) after 9 months of supervised exercise. They poured their hearts out on those treadmills 3-4 days a week for 9 months and still ended up no better than when they started. I have also seen similar data from some of my colleagues’ studies. So I really want diabetes research to invest the intellect and dollars into discovering what these roadblocks are—I happen to believe it is in the DNA (genetics) and the way that DNA is “read” or expressed (epigenetics). So it’s a bit of a ‘call to action’ for researchers to start looking into some of their data to find these people and better understand this phenomenon and for hopefully the funding sources to recognize this as a viable area of research.

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Physicans and Nurses Traumatized By Medical Errors

Alexandra Laurent Maître de conférences de psychologie clinique et psychopathologie Laboratoire de psychologie EA3188 Université de Franche-ComtéMedicalResearch.com Interview with :
Alexandra Laurent

Maître de conférences de psychologie clinique et psychopathologie
Laboratoire de psychologie EA3188
Université de Franche-Comté

Medical Research : What is the background for this study? What are the main findings?

Dr. Laurent: Human error among healthcare professionals is a subject of current affairs and especially in ICUs which are among the services with a high risk of error. If the error affects the patient and his/her family, it will also have an impact on the caregivers involved, their colleagues, and even the entire service. In an editorial in the BMJ, Wu introduced the term “the second victim” to define a caregiver implicated in and traumatised by an medical error for which he/she feels personally responsible. Therefore, it’s important to improve understanding of the psychological repercussions of error on professionals in ICUs, and to identify the defense mechanisms used by professionals to cope with errors.

In the month following the error, We found that the professionals (doctors and nurses) described feelings of guilt and shame. These feelings were associated with: anxiety states with rumination and fear for the patient; a loss of confidence; an inability to verbalize one’s error; questioning oneself at a professional level; and anger towards the team.

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Bleeding and Ischemic Events Following Bare Metal vs Drug Eluting Stents

Dean J. Kereiakes, MD FACC, FSCAI The Lindner Research Center The Christ Hospital Health Network Cincinnati, Ohio 45219MedicalResearch.com Interview with:
Dean J. Kereiakes, MD FACC, FSCAI
The Lindner Research Center
The Christ Hospital Health Network
Cincinnati, Ohio 45219

Medical Research: What is the background for this study?

Dr. Kereiakes: Bare metal stents (BMS) are a commonly used alternative to drug eluting stents (DES) particularly for patients presenting with acute coronary syndromes or in whom dual antiplatelet therapy (DAPT) has perceived increased bleeding risks. We aimed to determine whether the risks of stent thrombosis and major adverse clinical cardiovascular and cerebrovascular (MACCE; composite of death, MI or stroke) events differ for BMS versus DES and whether the optimal duration of dual antiplatelet therapy differs for BMS or DES. To answer these objectives we performed a propensity matched BMS to DES 0-33 month comparison as well as an analysis of treatment effect among BMS treated patients randomly assigned to 12 versus 30 months of DAPT.
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Three Cases of Cancer Misdiagnosed as Chronic Lyme Disease

MedicalResearch.com Interview with:
Christina Nelson, MD, MPH, FAAP

Medical Epidemiologist
Centers for Disease Control and Prevention
Division of Vector-Borne Diseases | Bacterial Diseases Branch
Fort Collins, CO

Medical Research: What is the background for this study?

Dr. Nelson: Evidence-based guidelines for the diagnosis and treatment of Lyme disease have been provided by the Infectious Diseases Society of America for many years. These comprehensive guidelines have been vetted by external review panels as the best option for patient care. In endemic areas, patients with the typical rash (erythema migrans) can be diagnosed with Lyme disease clinically. Otherwise, the guidelines recommend that diagnosis be based on a history of possible exposure, compatible clinical features, and positive two-tier serologic testing.

Some patients who have been treated for Lyme disease may develop post-treatment Lyme disease syndrome (PTLDS) – fatigue, arthralgias, or other symptoms that persist after completing antibiotic treatment. Although the exact cause of post-treatment Lyme disease syndrome is unknown, it is thought to be due to an altered immune response or residual damage to tissues during the acute infection. A diagnosis of exclusion, PTLDS should only be diagnosed after the patient has been thoroughly evaluated and other potential causes of symptoms ruled out.

On the other hand, “chronic Lyme disease” is a loosely defined diagnosis that has been used to describe a variety of ailments. A small cadre of providers use unconventional methods to diagnose patients with chronic Lyme disease, and sometimes there is no objective evidence that the patient ever had Lyme disease. Multiple factors contribute to this phenomenon, including misconceptions about serologic testing, use of unvalidated diagnostic tests, and clinical diagnosis of Lyme disease based on nonspecific symptoms alone.

We know that patients have been – and continue to be – harmed by treatments for chronic Lyme disease. Patients have suffered from emboli, severe allergic reactions to antibiotics, neutropenia, and infections such as Clostridium difficile. This is terrible and should never happen. However, there is another important danger related to these alternative practices. Some patients who have been diagnosed and treated for chronic Lyme disease later discover that another condition is the root of their physical problem. We wanted to highlight some of these cases in order to help educate providers and patients about this issue.

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For Weight Control, Focus on Healthy Foods, Not Calories

James J. DiNicolantonio, PharmD Associate Editor BMJ Open Heart Cardiovascular Research Scientist Saint Luke's Mid America Heart InstituteMedicalResearch.com Interview with:
James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke’s Mid America Heart Institute

Medical Research: What is the background for this study? What are the main findings?

Dr. DiNicolantonio: Focusing on calories misdirects eating away from healthy foods (that are higher in calories – such as nuts, salmon, and avocados) and towards harmful foods (e.g. rapidly absorbable carbohydrates – including added sugars such as table sugar and high fructose corn syrup).

Treating obesity should not focus on decreasing caloric intake, rather, it should focus on eating quality foods.  Lower calorie foods – that are high in rapidly absorbable carbohydrates – drive increased hunger throughout the day, whereas higher calorie foods (such as full-fat milk and eggs) leads to satiety.  Consuming rapidly absorbable carbohydrates leads to increased total caloric intake throughout the day (driven by insulin resistance and leptin resistance).  These metabolic consequences derived from overconsuming these types of foods leads us to eat more and exercise less.  In essence, eating more and exercising less doesn’t cause obesity, overconsuming rapidly absorbable carbohydrates causes us to eat more and exercise less, which then causes obesity – a subtle but important distinction.

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Stroke: Golden Hour Thrombolysis Improved Discharge To Home

MedicalResearch.com Interview with:
Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger
Center for Stroke Research Berlin (CSB)
Charité – Universitätsmedizin Berlin | CCM
Berlin | Germany

Medical Research: What is the background for this study? What are the main findings?

Response:
Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That’s because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial – both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities.

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Telephone Reminders May Increase Breast Cancer Screening

MedicalResearch.com Interview with
Dr. Jonathan Myles
Centre for Cancer Prevention, Queen Mary, University of London
Wolfson Institute of Preventive Medicine, Charterhouse Square, London

Medical Research: What is the background for this study? What are the main findings?

Dr. Myles: Breast cancer screening uptake is low in areas of high social deprivation and large populations of some ethnic groups.  The main  finding of this study is that an intervention in the form of contacting women by telephone a few days before the date of their screen, reminding them of their appointment and answering any queries they may have, significantly increases uptake.

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UK Drop in Antibiotic Prophylaxis Linked To Increased Number of Heart Infections

MedicalResearch.com Interview with:
Dr. Martin Thornhill PhD

Department of Cardiology, Taunton and Somerset NHS Trust
Taunton, Somerset, UK

Medical Research: What is the background for this study? What are the main findings?

Dr. Thornhill: In 2008 NICE introduced controversial new guidance recommending that antibiotic prophylaxis to prevent infective endocarditis should no longer be used. It was a rational decision, given the evidence for the effectiveness of antibiotic prophylaxis and potential concerns about costs, the development of antibiotic resistance and possible side effects from antibiotics, but it went against other guidelines from around the world that existed at the time.

The main findings are that in England:

  1. There has been a large and significant decline in the use of antibiotic prophylaxis.
  2. There has been a significant increase in the number of cases of infective endocarditis, above the baseline trend, using hospital coding data, corrected for changes in the size of the English population.

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Skin Cancer Lesions Not Affected By Agent Orange Exposure

MedicalResearch.com Interview with:
Naveed Nosrati MD

Indiana University School of Medicine
Staff Surgeon, Roudebush VAMC

Medical Research: What is the background for this study?

Dr. Nosrati: We originally began this study as a broader project investigating the effect of trauma induced by biopsies on the spontaneous clearance of a non-melanoma skin cancer. As part of that, we created a large database with many patient variables. Since we undertook this project at our local VA hospital, one of the variables available to us was Agent Orange exposure.

Shortly after completing the study, Clemens et al published their study linking Agent Orange exposure to higher rates of invasive non-melanoma skin cancer. Their study was a pilot study of only 100 patients. As we had well over 1,000 patients, we decided to pursue a side project of how Agent Orange specifically affects our results.

Our study was operating under the hypothesis that trauma induced by biopsies led to an inflammatory response that often led to the immunologic clearance of the remaining skin cancer. We actually coined the term “SCORCH” lesion, or spontaneous clearance of residual carcinoma histologically, for this phenomenon. With that mind, we would expect patients exposed to Agent Orange to theoretically have a more invasive form of malignancy and thus have lower rates of spontaneous clearance.
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More CT Scans Done For Minor Head Trauma Than Guidelines Recommend

Dr. Jennifer Marin MD MSc Director of Emergency Ultrasound, Division of Pediatric Emergency Medicine Assistant Professor of Pediatrics and Emergency Medicine University of Pittsburgh School of MedicineMedicalResearch.com Interview with:
Dr. Jennifer Marin MD MSc

Director of Emergency Ultrasound
Division of Pediatric Emergency Medicine
Assistant Professor of Pediatrics and Emergency Medicine
University of Pittsburgh School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don’t necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices.
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HPV Vaccination Rates Leaves Room For Improvement

Dr. Raquel Qualls-Hampton MD, MS Assistant Professor University of North Texas Health Science CenterMedicalResearch.com Interview with:
Dr. Raquel Qualls-Hampton MD, MS
Assistant Professor
University of North Texas Health Science Center

Medical Research: What is the background for this study? What are the main findings?

Dr. Qualls-Hampton: There are currently two vaccines approved by the Food and Drug Administration (FDA)—Gardasil for males and Gardasil and Cervix for females – that protect against the human papilloma virus (HPV). These vaccines are recommended by the ACIP for females ages 9 to 26 years and males ages 9 to 21 years. Both vaccines protect males and females against some of the most common types of HPV.  HPV vaccines are administered in three doses over six months and are considered safe and effective. However, the promise of these vaccines is going unfulfilled as initiation and completion rates for the three doses are suboptimal among females and males.

Nationally, although HPV vaccination initiation coverage is increasing, overall vaccine completion rates are at suboptimal levels and below the U.S. Department of Health and Human Services’ Healthy People 2020 initiative target of 80%. Thus, many states are turning to legislative interventions in efforts to increase initiation and completion rates. This study examines HPV vaccination legislative initiatives and their impact, specifically in estimating state legislation’s effects on HPV vaccine initiation, completion and patient care provider recommendations by gender.

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Patients With Type of Familial Sudden Death Need Long Term Follow Up

Giulio Conte MD Heart Rhythm Management Centre UZ-VUB Brussel, BelgiumMedicalResearch.com with:
Giulio Conte MD

Heart Rhythm Management Centre
UZ-VUB Brussel, Belgium

Medical Research: What is the background for this study? What are the main findings?

Dr. Conte: The evolution of Brugada syndrome from pediatric to adult age has not been previously evaluated. It has been shown that the electrocardiographic phenotype of Brugada syndrome do not manifest during childhood in the large majority of cases. Drug challenge with ajmaline is recommended to unmask the diagnostic electrocardiogram in patients with family history of Brugada syndrome and normal electrocardiograms. However, the ideal age to perform such screening has not been established yet. With this study we aimed to investigate the clinical value of repeating ajmaline challenge after puberty in pediatric family members with an initial negative drug test. Repeat ajmaline challenge after puberty unmasked Brugada syndrome in 23% of family members with a previously negative drug test. Of the newly positive patients, 30% developed symptoms, 10% ventricular fibrillation and 10% spontaneous Brugada type 1 electrocardiogram.
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Long Term Influence of Oral Contraceptives on Mortality

MedicalResearch.com Interview with:
Karin B. Michels, ScD, PhD
Associate Professor of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School

Medical Research: What is the background for this study? What are the main findings?

Dr. Michels: We were interested in studying the long-term effects of oral contraceptive use on mortality. Given the widespread use of oral contraceptives, this is an important question pertaining to millions of women worldwide.  We explored this question in the large Nurses’ Health Study, a cohort of 121,700 women in the US, who have been followed for 38 years. We found that oral contraceptive use does not impact overall mortality. However, breast cancer mortality was slightly increased, especially with long-term use of oral contraceptives.
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Lower Calorie Diets May Slow Aging and Memory Loss

Stephen D. Ginsberg, Ph.D., Associate Professor Departments of Psychiatry and Physiology & Neuroscience New York University Langone Medical Center Center for Dementia Research Nathan Kline Institute Orangeburg, NY  10962MedicalResearch.com Interview with:
Stephen D. Ginsberg, Ph.D., Associate Professor
Departments of Psychiatry and Physiology & Neuroscience
New York University Langone Medical Center
Center for Dementia Research
Nathan Kline Institute Orangeburg, NY  10962

Medical Research: What is the background for this study? What are the main findings?

Dr. Ginsberg: We tested the hypothesis that long-term calorie restriction positively alters gene expression within the hippocampus, a critical learning and memory area vulnerable in aging and Alzheimer’s disease. To test this hypothesis, we conducted experiments on female mice that were given food pellets 30% lower in calories than what was fed to the control group. The mice ate fewer calories derived from carbohydrates. Analyses were performed on mice in middle and old age to assess any differences in gene expression over time. Our data analysis revealed that the mice that were fed a lower calorie diet had fewer changes in approximately 900 genes that are linked to aging and memory. Continue reading

Hospital Readmissions May Not Be A Good Quality Indicator

MedicalResearch.com Interview with:
Ralitza P. Parina, MPH,
Senior medical student
John Rose, MD MPH
Department of Surgery at University of California San Diego

Medical Research: What is the background for this study? What are the main findings?

Response: This study looked at the association between hospital 30-day readmission rates and 30-day mortality rates. While readmission rates are coming into increasing focus with CMS reimbursement cuts for hospitals with higher than expected rates, they remain a poorly studied metric of quality. High readmission rates have been unequivocally tied to increased costs, but it remains unclear whether they actually represent poor quality of care and worse outcomes for patients. We chose to compare readmission rates as a quality metric to the well-established “gold standard” of mortality.

We found that 85% of hospitals did not show a correlation between readmission and mortality, i.e. their rates were not both high or both low. Furthermore, among hospitals that were outliers in at least one of the measures, almost a third were in the category of low or normal readmission rates with higher than expected mortality.

The implications are twofold: first, readmission and mortality rates are not strongly correlated.
Second, focusing on readmission rates as an outcome will miss a large number of poorly performing hospitals with higher than expected mortality rates but low or expected readmissions.

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US Skin Cancer Costs Top $8 Billion Annually

Gery P. Guy Jr., PhD, MPH, Health economist CDC: Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch.Medical Research.com Interview with:
Gery P. Guy Jr., PhD, MPH, Health economist
CDC: Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch.

Medical Research: What is the background for this study?

Dr. Guy: Skin cancer is the most commonly diagnosed cancer in the United States and is a growing public health problem. Melanoma, the deadliest form of skin cancer, is responsible for more than 12,000 deaths each year and is diagnosed in over 70,000 people per year. The number of skin cancer cases continues to increase every year, however little is known about the economic burden of treatment. The purpose of our study was to examine trends in the number of people treated for skin cancer and the cost of treatment.

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Addictions May Predispose To Excessive Gestational Weight Gain

Michele D. Levine Ph.D. Associate Professor of Psychiatry and Psychology Western Psychiatric Institute and Clinic Department of Statistics, University of Pittsburgh, Pittsburgh PAMedicalResearch.com Interview with:
Michele D. Levine Ph.D.

Associate Professor of Psychiatry and Psychology
Western Psychiatric Institute and Clinic
Department of Statistics, University of Pittsburgh, Pittsburgh PA

Medical Research: What is the background for this study? What are the main findings?

Dr. Levine: Many women quit smoking as a result of pregnancy.  However, psychiatric disorders, which are prevalent among smokers can contribute to weight gain.  Thus, we sought to examine the relationship between maternal psychiatric disorders and gestational weight gain in a sample of pregnant former smokers. Results from the present study demonstrate that the rates of psychiatric disorders were high among pregnant former smokers and that more than half of women gained more weight than recommended by the IOM.  Although a history of having had any psychiatric disorder was not associated with gestational weight gain, a history of alcohol use disorder specifically was positively related to gestational weight gain.

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Study Enhances Understanding of Genetic Mechanisms of Memory

Vijay Ramanan, PhD Indiana University Center for Neuroimaging (CfN) Department of Radiology Indianapolis, IN 46202MedicalResearch.com Interview with:
Vijay Ramanan, PhD
Indiana University Center for Neuroimaging (CfN)
Department of Radiology
Indianapolis, IN 46202

Medical Research: What is the background for this study? What are the main findings?

Dr. Ramanan: Impairment in episodic memory is one of the first clinical deficits in early Alzheimer’s disease, the most common cause of dementia.  Among other examples, this might be reflected as an inability to recall an article recently read or as difficulty remembering what one had for dinner last night.  Unfortunately, the genetic and environmental mechanisms underlying these deficits are not fully understood.  Our goal was to discover new genes and pathways underlying memory performance to help identify potential drug targets for protecting against and ultimately reversing memory loss in dementia and normal aging.

Through studying a large representative sample of older Americans, we discovered a variant (single nucleotide polymorphism or SNP) in the FASTKD2 gene associated with better memory performance and replicated this finding in independent samples.  We then integrated additional data to extend our understanding of the effect of this SNP.  For example, we know that the hippocampus is a vital brain structure for encoding and retrieving memories and it is well-understood that decreased hippocampal volume is a key early marker of Alzheimer’s disease and one that can be measured noninvasively through magnetic resonance imaging (MRI).  We predicted that this new memory-protective SNP would be associated with increased hippocampal volume and this turned out to be true.  We also discovered that carriers of this memory-protective SNP exhibited lower levels of proteins involved in cell death in the cerebrospinal fluid bathing the brain and spinal cord, a striking finding given that FASTKD2 encodes a protein that appears to promote apoptosis (i.e., programmed cell death).  Together, these convergent findings are consistent with a neuroprotective effect of this novel SNP discovery.  More broadly, our results nominate FASTKD2 and its functional pathways as potential targets for modulating neurodegeneration to combat memory loss in older adults.

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Flu Vaccination May Be Effective Even When Circulating Strain Different From Vaccine

MedicalResearch.com Interview with:
Maryam Darvishian MSc
Department of Epidemiology, University Medical Center Groningen,
Unit of PharmacoEpidemiology and PharmacoEconomics (PE2),
Department of Pharmacy, University of Groningen,
and 
Prof Edwin R van den Heuvel
Department of Epidemiology, University Medical Center Groningen,
University of Groningen, Groningen, Netherlands
Department of Mathematics and Computer Science,
Eindhoven University of Technology, Eindhoven, Netherlands

Medical Research: What is the background for this study?

Reply: In most developed countries, seasonal influenza vaccine is the standard care for elderly people, but there exists still discussions on whether vaccination is effective. Conducting RCT is not considered ethical and thus the main body of evidence comes from observational studies. Unfortunately, these studies (e.g. cohort studies) are susceptible to different sources of biases especially selection bias which makes it difficult to judge the effectiveness. In recent years test-negative design (TND) studies has been designed. It is a special type of case-control study which would limit the bias, due to similar health care-seeking behavior in cases and controls. The current study is a meta-analysis of TND case-control studies. It is the first meta-analysis of this type of studies and also the first meta-analysis that combined 35 studies for estimation of influenza vaccine effectiveness. More specifically, the meta-analysis assesses the influenza vaccine effectiveness against laboratory-confirmed influenza (LCI) among the elderly population. Continue reading