Working Memory Problems Can Persist Into Adulthood in Children with ADHD

Dr. Graham Murray PhD University Lecturer Department of Psychiatry Addenbrooke's Hospital Cambridge UKMedicalResearch.com Interview with:
Dr. Graham Murray PhD
University Lecturer
Department of Psychiatry
Addenbrooke’s Hospital
Cambridge UK

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

Dr. Murray: There is debate about the extent to which ADHD persists into adulthood, with estimates suggesting that between 10-50% of children still have ADHD in adulthood. Diagnosis (whether in childhood or adulthood) is currently reliant on meeting symptom checklists (such as the American Psychiatric Association’s Diagnostic and Statistical Manual), and a current diagnosis is often the prerequisite to access health care from psychiatric services. We decided to follow up a sample of 49 teens who all had a confirmed diagnosis of ADHD at age 16. We also followed a control group made up of comparison healthy volunteers from the same social, ethnic and geographical background.

When we used the symptom checklist criteria of persistence, only 10% of patients still met ADHD diagnostic criteria in adulthood. However, there is more to ADHD than this. When it comes to adult brain structure and function, it didn’t make any difference whether symptom checklists were still met or not. On reaching adulthood, the adolescent ADHD group show reduced brain volume in the caudate nucleus – a key brain region that supports a host of cognitive functions, including working memory function. When we assessed working memory ability, we noted persistent problems in the adolescent ADHD group, with a third of the adolescent ADHD sample failing the memory test. The poor memory scores seemed to relate to a lack of responsiveness in the activity of the caudate nucleus that we could detect using functional MRI scans. In the control group, when the memory questions became more difficult, the caudate nucleus became more active, and this appeared to help the control group perform well; in the adolescent ADHD group, the caudate nucleus kept the same level of activity throughout the test. It was as if, for the controls, when the test got harder, the caudate nucleus went up a gear in its activity, and this is likely to have helped solve the memory problems. But for the adolescence ADHD group, the caudate couldn’t go up a gear when the test became harder, and this likely resulted in poorer performance.  Continue reading

May Be Time To Stop Counting Calories

Dr Aseem Malhotra MBChB, MRCP Honorary Consultant Cardiologist - Frimley Park Hospital Consultant Clinical Associate to the Academy of Medical Royal Colleges Science Director- Action on Sugar Saving Londoners Lives - External Advisory Board MemberMedicalResearch.com Interview with:
Dr Aseem Malhotra MBChB, MRCP
Honorary Consultant Cardiologist –
Frimley Park Hospital
Consultant Clinical Associate to the Academy of Medical Royal Colleges
Science Director- Action on Sugar
Saving Londoners Lives – External Advisory Board Member

 

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

Dr. Malhotra: It is a review of all the research up to date on what is the impact of diet on health. What type of diet has the most robust evidence for weight and health and how this can be translated into policy to rapidly reduce the burden of chronic disease.

Medical Research: What should clinicians and patients take away from your report?

Dr. Malhotra:

  • That “low fat” diets to do not improve health outcomes and the public should
    stop counting calories.
  • That a high fat Mediterranean diet is more powerful in reducing the risk of
    heart attack and stroke than any medical treatment.
  • That it’s effect is independent of cholesterol lowering.
  • That rapid weight loss through calorie counting combined with exercise doesn’t
    only not improve health outcomes in the long term for diabetics but can also be
    potentially harmful by increasing CVD risk.

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Developed Countries More At Risk of Harboring Polio Virus Excreters

Dr Javier Martin PhD Principal Scientist Division of Virology National Institute for Biological Standards and Control (NIBSC) Medicines and Healthcare products Regulatory Agency (MHRA) Blanche Lane, South Mimms, Potters Bar United KingdomMedicalResearch.com Interview with:
Dr Javier Martin PhD
Principal Scientist
Division of Virology
National Institute for Biological Standards and Control (NIBSC)
Medicines and Healthcare products Regulatory Agency (MHRA)
United Kingdom


Medical Research: What is the background for this study?

Dr. Martin: The global eradication of polio appears to be within reach.  There has been no case of poliomyelitis caused by circulating wild type 2 poliovirus since 1999, no case of type 3 since November 2012 and the last case of type 1 in Africa was in August 2014, leaving some areas of Pakistan and Afghanistan as the main remaining reservoirs of circulating wild type 1 poliovirus. Poliovirus strains in the live-attenuated oral polio vaccine (OPV) are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation. These vaccine-derived poliovirus (VDPV) strains can transmit from person to person in populations with low immunity potentially leading to poliomyelitis outbreaks.

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miRNA-based Blood Test May Detect Early Pancreatic Cancer

Jenny Permuth Wey, PhD, MS Assistant Member Departments of Cancer Epidemiology and Gastrointestinal Oncology Moffitt Cancer Cente
MedicalResearch.com Interview with:
Jenny Permuth Wey, PhD, MS
Assistant Member
Departments of Cancer Epidemiology and Gastrointestinal Oncology
Moffitt Cancer Center

 

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

Dr. Wey: Pancreatic cancer is one of the deadliest cancers world-wide. It is currently the fourth leading cause of cancer-related deaths in the United States, and is predicted to become the second leading cause by 2030. Currently there are no accurate methods to diagnose pancreatic cancer early when a patient may be eligible for surgery to remove the tumor and hopefully survive longer. To beat this disease, early detection is key, and our team has dedicated efforts to studying pancreatic cancer in its ‘precancerous’ state because we and other researchers believe that the identification and treatment of precancerous pancreatic lesions offers a promising strategy to reduce the number of people losing their lives to this disease.

Similar to how colon polyps can progress into colon cancer, we now know that certain types of pancreatic cystic lesions can progress into pancreatic cancer. Pancreatic cancer precursors/pre-cancers known as intraductal papillary mucinous neoplasms (IPMNs) account for nearly one-half of the estimated 150,000 asymptomatic pancreatic cysts detected as ‘incidental findings’ on computed tomography (CT) scans or magnetic resonance imaging (MRI) scans each year during the clinical work-up for an unrelated condition.  Imaging alone cannot reliably distinguish between benign, pre-cancerous, and cancerous cysts, and cannot differentiate ‘low-risk’intraductal papillary mucinous neoplasms‘ (defined as low- or moderate-grade disease) that can be monitored from ‘high-risk’ IPMNs (defined as high-grade or invasive disease) that should be surgically removed.  The decision to undergo pancreatic surgery is not trivial for the patient and medical team since pancreatic surgery can be associated with an estimated 40% chance of complications and a 4% chance of death. Noninvasive tests are needed to accurately detect precancerous lesions of the pancreas so that personalized risk assessment and care can be provided.

microRNAs (miRNAs) are small molecules that act as ‘master-regulators’ of cancer-related processes in the body. One of the main purposes of our ‘proof of principle’ study was to measure miRNAs in the blood and determine whether a set of miRNAs could distinguish patients with IPMNs from healthy individuals. We then sought to determine whether a set of miRNAs could distinguish patients known to have ‘low-risk’ IPMNs from those with ‘high-risk’ IPMNs.  We show that new, relatively inexpensive digital technology could reliably measure miRNAs in blood plasma (the pale yellow liquid component of blood) from individuals newly-diagnosed with pancreatic cancer precursors (IPMNs) and healthy individuals.  Thirty miRNAs out of 800 tested showed higher levels in IPMN patients compared to healthy individuals, providing a preliminary ‘miRNA signature’ that may be found only in people with early pancreatic disease, suggesting it could serve as an early diagnostic tool.  Furthermore, we also provide preliminary data to suggest that a 5-miRNA signature can partially distinguish high-risk IPMNs that warrant resection from low-risk IPMNs that can be watched.  This is important clinically because it would be opportune to personalize care such that high-risk IPMNs that warrant resection are properly identified while individuals with low-risk IPMNs are spared the substantial  risks of mortality and morbidity associated with overtreatment from unnecessary surgery.

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Depression Risk Not Raised After Unsuccessful Fertility Treatments

MedicalResearch.com Interview with:
Camilla Sandal Sejbaek PhD
Department of Public Health
University of Copenhagen

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

Response: Previous literature have shown ambiguous results when investigating the association between becoming a mother and depression among women in fertility treatment. Small questionnaire-based studies with self-reported depression have shown that women in unsuccessful fertility treatment had a higher risk of depressive symptoms compared to women in successful fertility treatment. Two larger register-based studies using clinical depression (depression diagnosed at the psychiatric hospitals) have shown that women becoming a mother are at increased risk of clinical depression.

Our findings, from a large register-based study with about 41,000 women in assisted reproductive technology (ART) treatment, showed that women WHO became mothers had a higher risk of clinical depression compared to women in ART treatment WHO did not become mothers. The risk of clinical depression were more than five-fold higher within the first 6 weeks after becoming a mother to a live-born child.

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A Pint of Water Before Meals May Speed Weight Loss

Dr Helen Parretti NIHR Clinical Lecturer University of BirminghamMedicalResearch.com Interview with:
Dr Helen Parretti
NIHR Clinical Lecturer
University of Birmingham

Medical Research: What is the background for this study?

Dr Parretti: Drinking water is widely advocated as a useful tool in weight loss and is included in many weight loss programs, yet there is little evidence to support this in practice. Some initial small laboratory studies suggested drinking water before main meals might help with weight loss, but we didn’t know whether it would work in an everyday setting over a sustained period of time.

Medical Research: What are the main findings?

Dr Parretti: We recruited 84 people into the trial. 41 in the “preloading water” group and 43 in the comparator group. The people in the preloading water group were asked to drink 500ml (around 1 pint or 2 glasses) of water 30 minutes before each main meal and lost, on average 1.3kg (2.87lb) more than those in the comparator group over 12 weeks. Those who reported preloading before all three main meals in the day reported a loss of 4.3kg (9.48lbs) over the 12 weeks, whereas those who only preloaded once, or not at all, only lost an average of 0.8kg (1.76lbs).

Medical Research: What should clinicians and patients take away from your report?

Dr Parretti: We believe that drinking 500ml of water before main meals is a simple message that could easily be given by healthcare professionals to patients with obesity when they are giving weight loss advice. When combined with brief instructions on how to increase your amount of physical activity and on a healthy diet, it seems to help people to achieve some extra weight loss – at a moderate and healthy rate.

Just drinking about a pint of water, three times a day, before your main meals may help reduce your weight and it’s something that doesn’t take much work to integrate into our busy everyday lives

Medical Research: What recommendations do you have for future research as a result of this study?

Dr Parretti: We would like to carry out a larger trial with 12 month follow up to allow us to gain more definitive evidence that water preloading is effective and also to investigate the potential mechanisms of action more fully.  We are now looking to gain funding to carry out this research.

Citation:

Helen M. Parretti, Paul Aveyard, Andrew Blannin, Susan J. Clifford, Sarah J. Coleman, Andrea Roalfe, Amanda J. Daley. Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity: RCT. Obesity, 2015; DOI: 10.1002/oby.21167

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MedicalResearch.com Interview with:, & Dr Helen Parretti (2015). A Pint of Water Before Meals May Speed Weight Loss 

Sublingual Immunotherapy Not Currently Recommended For Asthma Control

Rebecca Normansell MA MB BChir Cochrane Airways Population Health Research Institute St George’s, University of London

MedicalResearch.com Interview with:
Rebecca Normansell MA MB BChir
Cochrane Airways
Population Health Research Institute
St George’s, University of London

 

 

Medical Research: What is the background for this study?

Response: Asthma is a common, long-term, respiratory condition which affects over 300 million people worldwide. It is a burden not only for the individual with asthma but also for the health services that care for them and the wider economy, due to days lost from work and school.

Asthma therapies aim to prevent attacks and improve symptoms by reducing airway constriction and inflammation, but they come with their own risks of side effects. For example, long-term high-dose inhaled corticosteroids have been associated with growth restriction in children and long-acting beta2-agonists as mono-therapy have been associated with increased risk of death in people with asthma.

There is growing interest in developing novel treatments for asthma and one such treatment is specific allergen immunotherapy. Immunotherapy has the potential to be a useful approach for asthma as it is thought that for approximately half of people with asthma, allergies are an important trigger for their symptoms and attacks. Immunotherapy can be delivered by injection (subcutaneously) or under the tongue (sublingually) and aims to bring about immune tolerance.

Immunotherapy has already been demonstrated to be effective in certain conditions, such as allergic rhinitis and wasp and bee sting allergy, but its effectiveness and safety in asthma is less clear. In fact, immunotherapy is not recommended at all for use in people with severe or uncontrolled asthma due to the risk of triggering a serious respiratory reaction.

Medical Research: What are the main findings?

Response: Our review looked for trials in which people with asthma who were given sublingual immunotherapy (SLIT) were compared with those given placebo, or who continued usual asthma care. We found 52 randomised controlled trials which met our inclusion criteria, allocating over 5,000 people to either SLIT or placebo/usual care. Most of the participants had mild asthma and were allergic to either house dust mite or pollen.

Despite the large number of eligible trials we were only able to perform a limited meta-analysis. This is because most of the trials did not report the efficacy outcomes we were most interested in: exacerbations and quality of life. Asthma symptoms and medication use were both more frequently reported, but often using different, un-validated scales so we did not perform a meta-analysis for these outcomes.

However, we were able to combine serious adverse event data from 22 trials involving 2560 participants and data for all adverse events from 19 trials including 1755 participants. SLIT did not appear to be associated with an increased risk of serious adverse events, although very few events were observed overall. SLIT was associated with a small increase in the risk of all adverse events, which in absolute terms equated to an increase from 222 per 1000 people in the control group to 327 per 1000 (95% confidence intervals 257 to 404). Importantly, many of these events were mild and transient local reactions and did not generally result in participants withdrawing from the trial.

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Twin Study Shows Rosacea Has 50:50 Genetic and Environmental Influences

Nely Aldrich, MD Department of Dermatology University Hospitals Case Medical CenterMedicalResearch.com Interview with:
Nely Aldrich, MD
Department of Dermatology
University Hospitals Case Medical Center

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

Dr. Aldrich:   To our knowledge, no formal studies have been performed on the genetic vs. environmental factors that lead to the development of rosacea. Our department has the unique opportunity to attend the Twins Days festival in Twinsburg, Ohio. This is a yearly festival where thousands of twin pairs come from all over the world. This was the perfect setting to ask our research question. Our main finding was that there is an approximately 50% contribution of genetics to rosacea and the other 50% can be attributed to environmental factors. Sun exposure, smoking, alcohol use, skin cancer history, and heart disease were also found to be correlated with a higher rosacea severity.

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Lice in Many States May Be Resistant To Common Treatments

Kyong Sup Yoon, Ph.D. Assistant Professor Department of Biological Sciences and Environmental Sciences Program Southern Illinois University-Edwardsville Edwardsville, IL 62026MedicalResearch.com Interview with:
Kyong Sup Yoon, Ph.D.

Assistant Professor
Department of Biological Sciences and Environmental Sciences Program
Southern Illinois University-Edwardsville
Edwardsville, IL 62026 

Medical Research: What is the background for this study? What are the main findings?
Response: Dr. John Clark (Professor, University of Massachusetts-Amherst) and I have been studying this matter for 15 years. The goal of our current study is to determine resistance (knockdown resistance or kdr conferred by 3 point mutations in voltage gated sodium channel alpha subunit gene) frequencies in US head louse populations collected from 48 contiguous states. We were able to analyze 109 populations from 30 states and found 100% kdr frequencies in 104 populations.  Hopefully, we can achieve our original goal in near future and publish it.

head lice, cdc imageMedical Research: What should clinicians and patients take away from your report?

Response: We need to implement practical resistance management. Now, for the first time since introduction of pyrethroids, we have different compounds already available or will be (hopefully) available in near future. We suggest to use mixture strategies to minimize development of resistance to any new products.

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Male Pattern Hair Loss Drugs Risk Significant Side Effects

Abdulmaged Traish; Photo by Vernon Doucette for Boston University Photography


MedicalResearch.com Interview with:
Abdulmaged M. Traish, MBA, Ph.D.
Professor of Biochemistry
Professor of Urology
Boston University School of Medicine
Boston, MA 02118

 

Medical Research: What is the background for this study?

 Dr. Traish: This study was undertaken to evaluate the data in the contemporary literature on the use of finasteride and dutasteride for treatment of ( benign prostatic hypertrophy) BPH and androgenetic alopecia (AGA). These drugs were proven effective in management of patients withy BPH andandrogenetic alopecia; however, these drugs inhibit a family of enzymes widely distributed in many tissues and organs and therefore may have undesirable effects. Most importantly, few studies have been undertaken to evaluate the effects of these drugs on the central nervous system. The adverse impact of these drugs on sexual function and well-being in a subset of patients raised the questions that we do not know much about the safety of such drugs.

Medical Research: What are the main findings?

 Dr. Traish: The main findings of this study is that these agents, while useful in treatment of BPH and androgenetic alopecia, exert undesirable side effects on sexual function and well-being. More importantly, limited data is available on the impact of these agents on the central nervous system.
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Light From Electronic Screens Can Disrupt Teenage Sleep Patterns

Stephanie J. Crowley, Ph.D. Assistant Professor Biological Rhythms Research Laboratory Department of Behavioral Sciences Rush University Medical Center Chicago, IL 60612MedicalResearch.com Interview with:
Stephanie J. Crowley, Ph.D.
Assistant Professor
Biological Rhythms Research Laboratory
Department of Behavioral Sciences
Rush University Medical Center
Chicago, IL 60612

Medical Research: What is the background for this study?

Dr. Crowley: Your readers may have seen recent reports by the American Academy of Pediatrics and the CDC about problems with early morning school bells for teens and the need to push school start times later.  These recent calls for later school start times come from data showing that biological processes make it challenging for a teen to get enough sleep and be rested for school when they have to wake up very early for school.  One of these biological processes is the circadian timing system, which is the approximate 24-hour brain clock that regulates the timing of sleep and wake.  During the teen years, the brain clock is shifted later making it more difficult for many teens to fall asleep early enough to get sufficient sleep on school nights.

Medical Research: What are the main findings?

Dr. Crowley: Melatonin suppression, as tested in this new study, is a good indication of how light affects the circadian system.  Our findings show that even a very small amount of light (similar to “romantic mood lighting”) in the evening suppressed melatonin levels in the middle-school-aged adolescents.  Because evening light “seen” by the brain clock shifts the clock later in time, the message is that biologically-driven later sleep times starts at this early age and needs to be considered when managing school and sleep schedules.

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Oncotype DX Assay Can Help Guide Adjuvant Breast Cancer Chemotherapy

Michaela Ann Dinan Ph.D. Assistant Professor in Medicine Member of Duke Cancer Institute Duke University School of MedicinMedicalResearch.com Interview with:
Michaela Ann Dinan Ph.D.

Assistant Professor in Medicine
Member of Duke Cancer Institute
Duke University School of Medicine

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

Dr. Dinan: For many years we have known that overall, women with early stage, hormone receptor positive breast cancer show an overall survival benefit from the receipt of adjuvant chemotherapy.  However, depending on the age of the patient, we have also known that between 3 to 10% of patients appear to be truly experiencing this survival benefit and that we are treating a lot of women unnecessarily.  The use of the Oncotype DX assay has provided additional information for patients to assess who at low risk of disease progression and can forgo chemotherapy.

In this study we looked to see whether the adoption of this assay was associated with reduce rates of chemotherapy in women over the age of 65.  We found that somewhat surprisingly, there was no overall association with receipt of the assay and use of chemotherapy.  However, in women who had high risk disease, receipt of the assay was associated with reduced rates of chemotherapy use.  In patients with low risk disease, receipt of the assay was associated with increased chemotherapy use.

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