Both Ibuprofen and Morphine Work For Childhood Fracture Pain

MedicalResearch.com Interview with:
Naveen Poonai MSc MD FAAP FRCPC
Paediatric Emergency Physician
Children’s Hospital, London Health Sciences Center
Assistant Professor Paediatrics and Internal Medicine
Schulich School of Medicine and Dentistry
London, Ontario,

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

Dr. Poonai: We found that in children discharged home with a fracture, both ibuprofen and oral morphine were effective at relieving pain. However, there were no significant differences in efficacy between the two agents and oral morphine was associated with more side effects.

MedicalResearch.com: What was most surprising about the results?

Dr. Poonai: The most surprising findings for us were that over 70% of children experienced pain significant enough to require analgesia once they were discharged home.  Furthermore, we were surprised to find that the anecdotally more potent agent morphine, was equivalent to ibuprofen for post-fracture pain relief in children.

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Smoking Cessation: Less Expensive Cytisine May Be As Effective As Nicotine Replacements

natalie_walkerMedicalResearch.com Interview with:
Natalie Walker, Ph.D.
National Institute for Health Innovation
School of Population Health, University of Auckland
Auckland, New Zealand

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

Dr. Walker: Cytisine is a plant-based alkaloid and is structurally similar to nicotine.  It is found in various plants from the Legume Family (Fabaceae), the third largest plant family on earth.  Cytisine is currently manufactured by Sopharma Ltd, Bulgaria (Tabex®) and Aflofarm Pharma, Poland (Desmoxan®) as a smoking cessation treatment, with the cytisine used in the tablets taken from a plant called Golden Rain (Laburnum anagyroides).  Cytisine has been available with and without prescription for smoking cessation since the 1960s, largely in Eastern Europe.   Cytisine is not currently registered for use in any Western countries (although regulatory approval is currently been sought for the USA , UK and Japan).

            We know from trial evidence that cytisine is better than a placebo for helping people quit smoking.  Cytisine is also one of the most affordable smoking cessation medicines available. It is much cheaper than nicotine patches, gum and/or lozenges and other smoking cessation medicine such as varenicline. This means smokers and governments are more likely to afford cytisine, especially those from low and middle income countries. However, we don’t know if cytisine is as good as nicotine patches and/or gum or lozenges, one of the most commonly used smoking cessation treatments in many western countries. We therefore undertook a pragmatic non-inferiority trial to answer this question, with recruitment of 1310 adult daily smokers who were motivated to quit, undertaken using the New Zealand national Quitline. Smokers were randomised to receive the standard 25 days of cytisine treatment or 8 weeks of nicotine patches and/or gum or lozenges.  Both groups received standard Quitline behavioural support.  Follow-up occurred at one week and one, two, and six months.

At all time points, cytisine was found to be better at helping people quit smoking than nicotine patches and/or gum or lozenges.  This finding was consistent irrespective of ethnicity, age, alcohol consumption, degree of cigarette dependence or whether participants smoked factory-made cigarettes or roll-your-owns. For reasons unknown, cytisine helped more women quit smoking than nicotine patches, gum and/or lozenges.  For men the effectiveness of the two products was similar.  Cytisine use made people less likely to relapse back to smoking. Those who did smoke when using cytisine didn’t enjoy smoking as much, and reduced the number of cigarettes they smoked.  Self-reported, non-medically verified adverse events were more common in those that used cytisine. Three out of every 10 people who used cytisine reported an adverse event, compared to 2 out of every 10 that used nicotine patches, gum and/or lozenges.  However the majority of reported side effects were mild and self-limiting. More people in the cytisine group experienced nausea, vomiting and sleep disturbances (e.g. bad dreams).

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Study Aims To Predict Outcomes of Neonatal Herpes Simplex Infections

Ann J. Melvin MD, MPH Division of Pediatric Infectious Disease Department of Pediatrics Seattle Children's Hospital, Seattle, WA 98105.MedicalResearch.com Interview with:
Ann J. Melvin MD, MPH
Division of Pediatric Infectious Disease
Department of Pediatrics
Seattle Children’s Hospital, Seattle, WA 98105.

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

Dr. Melvin: While relatively uncommon, neonatal Herpes Simplex Virus is a potentially devastating infection with significant morbidity and mortality.  We reviewed all of the neonatal HSV cases treated at our institution between 1993 and 2012 who had HSV DNA PCR results available from the plasma and/or CSF.  Most of the infants had quantitative PCR results available.  The objective of the study was to determine the clinical correlation of HSV PCR levels in the plasma and CSF.  We found a clear association between the plasma HSV level, clinical presentation and mortality.  All of the infants who died had HSV plasma DNA levels of greater than 7 log10 copies/ml.   However, neither plasma nor CSF HSV levels predicted neurologic outcome.   Clinical evidence of CNS disease was more predictive of neurologic outcome than was the CSF PCR level. We also showed the most sensitive test for diagnosis of neonatal HSV to be HSV PCR on the plasma.  However, no single test diagnostic test (plasma PCR, CSF PCR, surface cultures) was positive across all infants, so it is important to obtain samples from plasma, CSF and surface swabs in infants with symptoms consistent with HSV infection.

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What Causes Greater Variability in Lifespans In Black Americans?

Glenn Firebaugh, Ph.D. Roy C. Buck Professor of American Institutions, Sociology, and Demography College of the Liberal Arts The Pennsylvania State University University Park, PAMedicalResearch.com Interview with:
Glenn Firebaugh, Ph.D.
Roy C. Buck Professor of American Institutions, Sociology, and Demography
College of the Liberal Arts
The Pennsylvania State University University Park, PA

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

Dr. Firebaugh: Lifespans are more variable for blacks than for whites in the United States. The objective of this study was to determine why. Is it because blacks are more likely to die of causes, such as homicide, that disproportionately strike the young and middle-aged, or because age at death varies more for blacks than for whites among those who die of the same cause? It is primarily the latter. For almost all causes of death, age at death varies more among black victims than it does among white victims, especially for women. To be sure, some youthful causes of death, such as homicide and AIDS, are more prevalent among blacks, accounting for some of the greater variances in blacks’ lifespans. But these causes are largely offset by higher rates of suicide and drug poisoning deaths among whites. As a result, differences in causes of death for blacks versus whites on net account for relatively little of the difference in lifespan variance for blacks and whites.

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Burn Patients: White Blood Cell Motility Predictive of Sepsis

Daniel Irimia, M.D., Ph.D. Assistant Professor  Division of Surgery, Science & Bioengineering Massachusetts General Hospital and Harvard Medical School Associate Director, BioMEMS Resource Center Boston, MA 02129MedicalResearch.com Interview with:
Daniel Irimia, M.D., Ph.D.
Assistant Professor
Division of Surgery, Science & Bioengineering
Massachusetts General Hospital and Harvard Medical School
Associate Director, BioMEMS Resource Center
Boston, MA 02129

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

Response: Sepsis is affecting more than half of the patients with major burn injuries (20 percent of body surface) and is the leading cause of death among these patients.  Sepsis is also a significant complication for other critically ill patients. More than one million Americans are affected and it has been estimated that approximately 30% of these people die, despite significant advances in life support and antibiotics.  Early diagnosis is essential, and it has been calculated that every 6 hours of delay in a sepsis diagnosis decreases the chances of survival by 10 percent.

We have found that the motility of the white blood cells called neutrophils, inside a microfluidic device, is significantly altered two to three days before sepsis develops. Continue reading

NSAIDS May Prevent Some Squamous Cell Skin Cancers

MedicalResearch.com Interview with:
Dr Catherine Olsen  |  Senior Research Officer
QIMR Berghofer Medical Research Institute
Royal Brisbane Hospital, QLD 4029

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

Response: Squamous cell carcinomas (SCCs)are the second most common skin cancer occurring in white skinned populations. They cause significant morbidity as they can invade local structures (often the nose or ears) and they also have the potential to metastasize although most are successfully treated before any spread occurs. They are also very expensive cancers to treat because they are so common, posing a significant burden on health care budgets. NSAIDS have been shown to be protective for other cancers (e.g. colorectal and oesophageal cancer). This prompted use to evaluate all of the available evidence on NSAIDs use and SCC by conducting a systematic review and meta-analysis of the association.
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Pilots and Cabin Crew Fly With Greater Risk of Melanoma

Martina Sanlorenzo, MD Department of Dermatology Mount Zion Cancer Research Center University of California, San FranciscoMedicalResearch.com Interview with:
Martina Sanlorenzo, MD
Department of Dermatology
Mount Zion Cancer Research Center
University of California, San Francisco


Medical Research: What is the background for this study?

Dr. Sanlorenzo: We recently performed a meta-analysis and found an increased risk of melanoma in pilots and cabin crew. One of the possible occupational hazards responsible for this risk is UV radiation.

Medical Research: What are the main findings?

Dr. Sanlorenzo: We performed UV measurements in airplane cockpits during flight and we found that windshields blocked UV-B but allowed UV-A transmission. We compared the UV-A dose in airplanes with the UV-A dose in tanning beds, whose use is a known risk factor for melanoma. Pilots flying for 56.6 minutes at 30,000 feet received the same amount of UV-A carcinogenic effective radiation of a 20-minute tanning beds session.
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Age of Menarche Linked To Heart Disease Onset

MedicalResearch.com Interview with:
Dexter Canoy, PhD
Cancer Epidemiology Unit, Nuffield Department of Population Health
University of Oxford, United Kingdom

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

Response: Over a million middle-aged women in the UK who took part in our study between 1996 and 2001 provided information regarding their health and lifestyle, including their reproductive history such as age when they had their first menstruation. We followed them for over 10 years and identified those who developed heart disease (and other vascular diseases) by obtaining information on hospitalizations and death records. Our study demonstrates that on average, women with menarche before age 13 or after this age have slightly increased risks of developing heart disease, stroke and hospital admissions associated with hypertension. The increased risks for these vascular diseases were highest in women with menarche at age 10 years or younger, or age 17 years or older. This U-shaped association was consistently found among lean, overweight and obese women, among never, past or current smokers, or among women in low, middle or high socioeconomic group.

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Hospital-Based Exercise Program Reduced Pain, Improved Quality of Life

Sandra Goldsmith, MA, MS, RD Director of Public and Patient Education at Hospital for Special Surgery New York City.MedicalResearch.com Interview with:
Sandra Goldsmith, MA, MS, RD
Director of Public and Patient Education at Hospital for Special Surgery
New York City.

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

Response: Almost 50 million adults in the United States suffer from some form of musculoskeletal disorder, which can affect their mobility and quality of life. Osteoarthritis (OA) is the leading cause of disability in the U.S. and affects more than 70 percent of adults between the ages of 55 and 78. Research has shown that there is a connection between being physically active and maintaining joint health, pain relief and improved quality of life. This study attempts to support the efficacy of Hospital for Special Surgery’s hospital-based exercise programs in increasing physical activity and improving quality of life through pain relief and improved stiffness, fatigue and balance in the older adult community.

This study found that after taking the exercise classes, fewer participants reported experiencing a high level of muscle/joint pain from their condition (56 percent before the program started vs. 47 percent after completing the program). The study also reported improved quality of life, as evidenced by statistically significant reductions in how much their pain interfered with their general activities, ability to walk, mood, sleep and enjoyment of life. In addition, 83 percent of participants indicated a reduction in stiffness; 82 percent said they felt their balance improved; and 67 percent said they experienced less fatigue as a result of taking part in the program. Health outcomes were also related to the type of exercise class participants chose, with the greatest reduction in muscle/joint pain reported by those who took t’ai chi.

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Obesity Linked To Blood Pressure Day-to-Day Variability

Mohammed Elfaramawi , MD PhD MPH MSc Assistant Professor Epidemiology Department College of Public Health University of Arkansas for Medical Sciences Little rock, AR 72205 MedicalResearch.com Interview with:
Mohammed Elfaramawi , MD PhD MPH MSc
Assistant Professor
Epidemiology Department
College of Public Health
University of Arkansas for Medical Sciences
Little rock, AR 72205

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

Dr. Elfaramawi: A substantial increase in prevalence of obesity has been documented globally. In the USA, overweight and obesity are the second leading cause of preventable death in the USA, affecting ∼97 million adults. Evidence has accumulated showing that visit-to-visit blood pressure variability is associated with adverse cardiovascular outcomes. This study is one of few studies which explored the relationship between obesity and visit-to-visit blood pressure variability. Continue reading

DNR Orders Improved Quality of Life In Week Before Death

MedicalResearch.com Interview with:
Melissa Garrido, PhD

Research Health Science Specialist
GRECC, James J Peters VA Medical Center, Bronx, NY
Assistant Professor Brookdale Department of Geriatrics & Palliative Medicine
Icahn School of Medicine at Mount Sinai, New York, NY and

Holly G. Prigerson, PhD
Center for Research on End of Life Care
Weill Cornell Medical College New York, NY 10065

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

Response: Recent proposals in Congress encourage patients to engage in advance care planning and to complete advance directives. That is, patients are encouraged to have conversations about end-of-life care preferences and to document these preferences in writing (through living wills or medical orders such as do not resuscitate (DNR) orders) or to designate a durable power of attorney who can honor their preferences. The goal of advance care planning is to ensure that seriously ill patients receive care that matches their values. In this study, we used data from a prospective study of patients with advanced cancer and their caregivers to examine whether living wills, durable powers of attorney, and DNR orders were associated with better quality of life and lower estimated costs of care in the week before death. We examined these relationships among patients who did and did not express preferences for “heroic” end-of-life care (everything possible to remain alive).

Medical Research: What are the main findings?

Response: DNR orders were associated with better quality of life in the week before death among the entire sample. If patients have DNR orders completed, they are likely to have a better quality of life/quality of death than if they do not complete a medical order like this.

We did not find any evidence of a relationship between DNR orders and costs of care, nor did we find evidence of relationships among living wills or durable powers of attorney, quality of life, and costs of care. There was no evidence that relationships among advance care planning and outcomes differed by patient preferences for heroic care.
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Brain Injury: Using Music Video Eye Tracking To Predict Recovery

Uzma Samadani, MD. PhD. FACS. Chief Neurosurgeon New York Harbor Health Care System Co-Director Steven and Alexandra Cohen Veterans Center for PTSD and TBI Assistant Professor Departments of Neurosurgery, Psychiatry and Physiology & Neuroscience New York University School of Medicine New York , NY 10010MedicalResearch.com Interview with:
Uzma Samadani, MD. PhD. FACS.
Chief Neurosurgeon New York Harbor Health Care System
Co-Director Steven and Alexandra Cohen Veterans Center for PTSD and TBI
Assistant Professor Departments of Neurosurgery, Psychiatry and Physiology & Neuroscience
New York University School of Medicine New York , NY 10010

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

Dr. Samadani: Eye tracking has been used for 30 years to investigate where people look when they follow particular visual stimuli.  Tracking has not, however, been previously used to assess underlying capacity for eye movement.  We have developed a very unique eye tracking algorithm that assesses the capacity of the brain to move the eyes.

What we show in this paper is that with our eye tracking algorithm we can show
(1) normal people have eye movements that, within a particular range, have equal capacity for vertical and horizontal movement,
(2) people with specific weaknesses of the nerves that move the eyes up and down have decreased vertical capacity,
(3) people with weaknesses in the nerves that move the eyes to the side have decreased horizontal capacity,
(4) swelling in the brain can affect the function of these nerves and be detected on eye tracking,
(5) eye tracking may be useful as a potential biomarker for recovery from brain injury.

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Cocaine Chief Cause of Cardiovascular Death In Young People

MedicalResearch.com Interview with:
Luis F. Callado M.D., Ph.D.
Department of Pharmacology
University of the Basque Country
CIBERSAM

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

Dr. Callado: Cocaine is the most commonly used illicit stimulant drug in Europe. The use of cocaine has become a major issue for drug policy, with also important health implications, including potentially lethal cardiovascular complications. In this way, several case series have suggested a relationship between cocaine use and cardiovascular diseases in young adults. Furthermore, cocaine use has been also associated with sudden and unexpected death.

Our results demonstrate that the recent use of cocaine is the main risk factor for sudden cardiovascular death in persons between 15 and 49 years old. Thus, persons that consumed cocaine recently presented a 4 times higher risk for sudden cardiovascular death than those who did not use cocaine. The morphological substrate of sudden cardiovascular death associated to cocaine use is a structural pathology not diagnosed in life. Usually, sudden death is the first manifestation of the disease.

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Public Disclosure of Antibiotic Prescription Rates Decreased Usage

Dong Wook Shin, MD, MBA, DrPH Assistant Professor, Center for Health Promotion/Dept.of Family Medicine Seoul National University HospitalMedicalResearch.com Interview with:
Dong Wook Shin, MD, MBA, DrPH

Assistant Professor, Center for Health Promotion/Dept.of Family Medicine
Seoul National University Hospital

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

Response: In South Korea, the National Health Insurance provides universal coverage and the Health Insurance Review & Assessment Service (HIRA) oversees claims reviews. HIRA has reported the rates of antibiotic prescriptions for upper respiratory tract infections in each clinic via web site since 2006. We assessed the effect of public disclosure.

The main findings are that decreases of antibiotic uses were observed since the public disclosure of the prescription rates regardless of hospital level.
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Over Half Colon Cancer Deaths Due To Not Getting Screened

MedicalResearch.com Interview with:
Reinier G.S. Meester, M.Sc
Department of Public Health,
ErasmusMC, Rotterdam, Netherlands

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

Response: Despite decreasing death rates from colorectal cancer over the past decades, it still ranks as the second leading cause of cancer deaths in the U.S. Screening for colorectal cancer is highly effective, but only 58% of the eligible population reported up-to-date with screening. This suggests that a substantial proportion of current colorectal cancer deaths in the U.S. are avoidable.

We found that approximately 60% (32,200 deaths) of current deaths from colorectal cancer may be due to not receiving screening.
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Gene Mutation Identified In Metastatic Breast Cancer

Dr. Ryan Hartmaier PhD Postdoctoral Associate Magee-Womens Research Institute (MWRI) and the University of Pittsburgh Cancer InstituteMedicalResearch.com Interview with:
Dr. Ryan Hartmaier PhD
Postdoctoral Associate
Magee-Womens Research Institute (MWRI)
and the University of Pittsburgh Cancer Institute

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

Response: The inhibition of signaling through the estrogen receptor is a major target in breast cancer therapy. However, within recurrent disease others have recently identified point mutations within the estrogen receptor as a mechanism of resistance to this therapy.
We undertook a comprehensive study of breast cancer progression by applying many next-generation sequencing technologies to a collection of paired primary-metastasis tissue samples from 6 patients. We placed special emphasis on the identification of structural variants (i.e. translocations, duplications, inversions, and deletions) acquired in metastatic breast cancer. In one patient with recurrent disease while on endocrine therapy, we identified a fusion gene between ESR1 (estrogen receptor alpha) and DAB2 (disabled-2). In vitro functional studies indicate that this fusion is constitutively active and hormone independent.
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Zinc Isotopes May Be Breast Cancer Biomarker

Fiona Larner, PhD Postdoctoral Research Associate Department of Earth Sciences, University of Oxford, South Parks Road, Oxford, UK Department of Earth Science & Engineering, Imperial College London, Exhibition Road, South Kensington, London, UKMedicalResearch.com Interview with:
Fiona Larner, PhD
Postdoctoral Research Associate
Department of Earth Sciences, University of Oxford, South Parks Road, Oxford, UK
Department of Earth Science & Engineering, Imperial College London, Exhibition Road, South Kensington, London, UK

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

Response: Zinc has been identified to have a role in breast tissue and breast cancer for over a decade. Zinc has several isotopes (different versions of zinc due to varying numbers of neutrons), which require slightly different amounts of energy to go through biological processes. By measuring the changes in the zinc isotopic signature, we can probe it’s behaviour to a greater resolution to that currently available in medical institutions. We looked at the isotopic signatures in different tissues of healthy patients and those with breast cancer in order to understand the mechanisms involved in more detail and in search for a biomarker that uses these signatures to diagnose breast cancer.

We found that breast cancer tissue preferentially retains the lighter isotopes of zinc to a greater extent than healthy breast tissue. This means that the partnering heavy isotopes must be ejected from the cell, and may provide a biomarker for cancer in the future.

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Celebrity Illness Drives Online Search: Robin Williams Effect

Francesco Brigo, MD Department of Neurological and Movement Sciences. Section of Clinical Neurology. University of Verona. Division of Neurology, "Franz Tappeiner" Hospital. Merano (BZ), ItalyMedicalResearch.com Interview with:
Francesco Brigo, MD
Department of Neurological and Movement Sciences.
Section of Clinical Neurology. University of Verona.
Division of Neurology, “Franz Tappeiner” Hospital.
Merano (BZ), Italy

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

Dr. Brigo: Millions of people surf the Internet every day as a source of health care information looking for materials about symptoms, diagnosis, treatments and their possible adverse effects, or diagnostic procedures. The increasing number of online searches conducted using popular Web search engines, such as Google, generates so-called ‘big data’. This data provides information about online health-related behavior. In this study, I found that the highest peak in Google search volumes related to the terms “Parkinson´s disease” since January 2004 was observed on 15th August 2014, the day after Robin Williams’ wife has revealed the late actor, who died of suicide on 11th August, was in the early stages of Parkinson’s disease.  I proposed to call the phenomenon of increased online searches for a certain disease driven by news of celebrities having that disease as “Robin Williams´ phenomenon”, in honor of the American actor.

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CDC ‘Tips From Former Smokers Campaign’ Proves Cost Effective

MedicalResearch.com Interview with:
Xin Xu, Ph.D.
Senior Economist Office on Smoking and Health and

Darryl Konter
Health Communications Specialist
McNeal Professional Services
Centers for Disease Control and Prevention
Office on Smoking and Health
Atlanta, GA 30341

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

Response: Tips From Former Smokers (Tips), the first federally funded national mass media antismoking campaign, launched by the CDC, provides a unique opportunity to assess the cost effectiveness of a nationwide public health intervention that meets the ad exposure recommendation in CDC’s 2014 Best Practices for Comprehensive Tobacco Control Programs.  The 2012 campaign spent $393 per year of life saved—far less than the $50,000 per year of life saved figure used as a common threshold for cost-effectiveness. The campaign  added about 179,000 healthy life years, at $268 per healthy year gained. The campaign spent about $480 per smoker who quit. The campaign averted more than 17,000 premature deaths, at a cost of about $2,200 per premature death averted.
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Emergency Room Visits Related to Indoor Tanning

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

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

Dr. Guy: Indoor tanning exposes users to intense UV radiation and is associated with an increased risk of skin cancer. However, little is known about the more immediate adverse outcomes of indoor tanning. This study provides the first national estimates of visits to emergency departments related to indoor tanning. We examined cases from the Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS), a national probability sample of hospitals in the U.S. and its territories. Patient information is collected from each NEISS hospital for every emergency visit involving an injury associated with consumer products. From this sample, the total number of product-related injuries treated in hospital emergency rooms nationwide can be estimated.

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Breast Cancer: Ovarian Suppression May Benefit Some Young Patients

Prudence A. Francis, M.D Associate Professor , Peter MacCallum Cancer Centre Melbourne, AustraliaMedicalResearch.com Interview with:
Prudence A. Francis, M.D
Associate Professor, Peter MacCallum Cancer Centre
Melbourne, Australia

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

Response: The background for this study was the observation that premenopausal women diagnosed with hormone receptor positive breast cancer under age 35, had an increased risk of recurrence, as compared with older premenopausal women. We postulated that this might be because this age group was less likely to enter menopause after receiving chemotherapy, and so their ovaries were continuing to produce estrogen, which might have the effect of stimulating any remaining cancer cells.

The main findings were that while not all premenopausal women benefit from the addition of treatment with ovarian function suppression to tamoxifen, the women who underwent chemotherapy and remained premenopausal (median age 40) did have improved breast cancer outcomes. This same group of women had even further improvement in recurrence rates if the ovarian suppression was combined with an aromatase inhibitor exemestane, as compared with tamoxifen. The effects of including ovarian suppression were particularly striking in women under 35 years of age. Those premenopausal women who did not receive chemotherapy (median age 46) after discussion with their doctor, did well with tamoxifen alone and do not appear to benefit from ovarian suppression currently.

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Study Highlights Unpredictable Anticoagulation With Warfarin

Winnie Nelson PharmD, MS, MBA Director, Health Economics & Outcomes Research Janssen PharmaceuticalsMedicalResearch.com Interview with:
Winnie Nelson PharmD, MS, MBA

Director, Health Economics & Outcomes Research
Janssen Pharmaceuticals

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

Dr. Nelson: Although warfarin has long served as the standard of care for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF), research has shown nearly one-third of international normalized ratio (INR) levels among stabilized patients on warfarin are out-of-range. Data recently published in the International Journal of Clinical Pharmacy underscores the potential complications of out-of-range INRs, with the aim of informing patient care.

The analysis of a U.S. Veterans Health Administration dataset showed out-of-range INRs were associated with a significantly increased risk of adverse clinical outcomes, including stroke and major bleeding. Of particular interest, the study also showed the magnitude of risk of thromboembolic events – such as ischemic stroke – was several folds higher in sub-therapeutic INR levels (i.e., INR <2) than risk of bleeding events when INR measures were >3. In another words, the research found more risks to patients when INRs were too low than when INRs were too high.
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Discovering A Protein That Blocks Cells From Becoming Fat Cells

Dr. Richard Phipps PhD Department of Environmental Medicine and Flaum Eye Institute, School of Medicine and Dentistry, University of Rochester, Rochester, New YorkMedicalResearch.com Interview with:
Dr. Richard Phipps PhD
Department of Environmental Medicine and Flaum Eye Institute,
School of Medicine and Dentistry, University of Rochester, Rochester, New York

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

Response: Obesity has risen dramatically over the past 30 years in the United States and throughout the world. Obesity increases morbidity and mortality by increasing health problems such as Type 2 diabetes, cardiovascular disease and cancer. Thus, obesity is one of our greatest challenges worldwide. Our laboratory has been studying a protein called Thy-1 for several decades. Until now its’ true function was unknown. The main finding from our research is that when cells express this protein on their surface, they are inhibited from becoming fat cells. We show in a mouse model system that mice, which lack Thy-1, and given a high fat diet, increase weight much faster than mice that express Thy-1. These mice that lack Thy-1, also have increased levels of many proinflammatory mediators in their blood. In human cells, those that express high levels of Thy-1 are blocked in their ability to become fat cells, unlike the human cells from different tissues that do not express Thy-1. Thus, the main finding is that learning how to manipulate Thy-1 expression could lead to reduced fat cells and reduced fat production. Not only is this an important finding for obesity, but there are many human diseases that are caused by excess fat production in organs, such as, the orbit of the eye, the liver, and the bone marrow.

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White Fat May Be Converted Into Energy Burning Brown Fat

Susanne Mandrup Professor, Department of Biochemistry and Molecular Biology Odense M · DenmarkMedicalResearch.com Interview with:
Susanne Mandrup
Professor, Department of Biochemistry and Molecular Biology
Odense M · Denmark

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

Prof. Mandrup: Obesity affects more than 1 billion adults globally and represents one of the greatest current threats to human health. Paradoxially, the fat tissues in the human body that stores excess calories might hold the key for a future obesity treatment.

Most human fat depots are white fat tissues that store energy as fat; however, humans also have small amounts of brown fat, which primarily acts as an effective fat burner for the production of heat. Recent studies have shown that it is possible to “brown” white fat tissues (e.g. by prolonged cold-exposure) leading to an increase in the energy consumption of the body. The challenge is to understand how energy storing white fat cells are reprogrammed into so-called “brite” (brown-in-white) fat cells in the white adipose tissue and thus make adipose tissue burn off excess energy as heat instead of storing it.

In this study we have for the first time investigated how the genome of white fat cells is reprogrammed during browning. We stimulated browning in human white adipocytes by a drug used to treat type II diabetes and compared white and “brite” fat cells. This showed that “brite” fat cells have distinct gene programs which, when active, make these cells particularly energy-consuming. Furthermore, we identified an important factor in the browning process – the gene regulatory protein KLF11 (Kruppel Like Factor-11). Continue reading

Physician Maintenance of Certification Linked to Decreased Health Care Costs

Bradley M. Gray, PhD American Board of Internal MedicineMedicalResearch.com Interview with:
Bradley M. Gray, PhD
American Board of Internal Medicine

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

Dr. Gray: The American Board of Internal Medicine (ABIM) is committed to evaluating the impact its physician certification programs, including Maintenance of Certification (MOC). That motivated us to investigate the relationship between the MOC requirement and the practice patterns of internists subject to it.

We looked to see whether the original MOC requirement was associated with health care costs and measures of hospitalizations drawn from Medicare claims. Our primary measure of hospitalizations was Prevention Quality Indicators, which were developed by the Agency for Health Care Research and Quality to measure impacts of primary care. These include such things as hospitalizations for an amputation due to diabetic complications. Our health care cost measure included outpatient and inpatient costs.

To examine these associations, we took advantage of a natural experiment that occurred when one group of general internists who originally certified in 1991 were subject to the MOC requirement by 2001, while another group of internists, who originally certified just two years earlier in 1989, were grandfathered out of this requirement.

In essence we can think of the 1991 required group of internists as a group treated by the effects of MOC and the 1989 grandfathered group as a control group in a natural experiment.

We estimated associations with this requirement by comparing outcomes among Medicare beneficiaries treated by the required group of internists before and after the requirement took effect in 2001.

Also before and after the 2001 requirement, we compared this difference to a similar difference in outcomes for a control group of beneficiaries treated by the grandfathered group of internists. At base line before 2001, these beneficiaries had almost identical characteristics and co-morbidities as the beneficiaries treated by the required group of internists.

We did this to account for the natural increase in hospitalizations and health care costs that occur as beneficiaries age, as well as other important factors that might have been coincident with the MOC requirement.

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