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MedicalResearch.com specializes in exclusive interviews with medical researchers from major and specialty journals and presenters at health care meetings.
Learn directly from the researchers as they discuss the ideas behind their investigations and their plans for future studies. Over 8320 interviews to date! More than 1600 interviews with researchers from JAMA.

Are You A ‘Material Girl’ (or Boy)? Then You Love Facebook

MedicalResearch.com Interview with:
“FACEBOOK(LET) Front” by FACEBOOK(LET) is licensed under CC BY 2.0
Phillip Ozimek M.Sc.
Department of Social Psychology Faculty of Psychology Ruhr-University Bochum UniversitätsstrBochum, Germany

MedicalResearch.com: What is the background for this study?

Response: We started reading the classic book by Erich Fromm „To have or to be“ out of personal interest. I was very much interested in studying social media, so we wondered how materialists would use facebook. After all Facebook seemed to be a perfect tool for people who love social comparisons.

Furthermore, Facebook is for free – materialists love tools that do not cost money!

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Intestinal Microbiome Alterations May Trigger Immune Reactions Inducing Multiple Sclerosis

MedicalResearch.com Interview with:

multiple sclerosis on mri Wikipedia Image James Heilman, MD

Multiple sclerosis as see on MRI

Kouichi Ito, PhD
Associate Professor
Department of Neurology
Robert Wood Johnson Medical School
Rutgers

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Multiple Sclerosis (MS) is an autoimmune disease of the central nervous system (CNS), and breakdown of immune tolerance to CNS proteins has been suggested to initiate CNS autoimmunity. Although the mechanism underlying the breakdown of immune tolerance to CNS proteins is still unknown, gut microbiota has been suggested to be involved in disease initiation and progression.

To investigate the etiology of Multiple Sclerosis, we have created humanized transgenic mice expressing MHC class II and T cell receptor genes isolated from an Multiple Sclerosis patient and showed that gut dysbiosis, alteration in intestinal microbial composition, can induce gut leakiness and subsequently trigger the development of neurological deficits through activation of complement C3 and reduction of CBLB and Foxp3 genes.

This study suggests that gut dysbiosis is one of the possible etiological factors for Multiple Sclerosis.

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Infectious Prions Detected in Skin of Patients With Neurodegenerative Creutzfeldt-Jakob Disease

MedicalResearch.com Interview with:

The brain of one patient who died from sporadic Creutzfeldt-Jacob disease (sCJD) appears nearly identical to the brain of a mouse inoculated with infectious prions taken from the skin of patients who died from sCJD.

The brain of one patient who died from sporadic Creutzfeldt-Jacob disease (sCJD) appears nearly identical to the brain of a mouse inoculated with infectious prions taken from the skin of patients who died from sCJD.
Case Western Reserve University

 

Byron Caughey, Ph.D.
Senior Investigator
Chief, TSE/prion Biochemistry Section
Laboratory of Persistent Viral Diseases
NIH/NIAID Rocky Mountain Laboratories
Hamilton, MT 

 

 

MedicalResearch.com: Would you briefly explain what is meant by Creutzfeldt-Jakob disease?

Response: Creutzfeldt-Jakob disease (CJD) is an incurable—and ultimately fatal—transmissible, neurodegenerative disorder in the family of prion diseases. Prion diseases can be found in many mammalian species and are due to the conversion of normally harmless prion protein molecules into abnormally folded, aggregated and self-propagating clusters and filaments in the brain. The accumulation of these clusters has been associated with tissue damage that often leaves dying neurons and microscopic sponge-like holes in the brain. In the sporadic and genetic forms of CJD this pathogenic process appears to arise spontaneously in the patient.

However, the transfer of the prion protein aggregates from a Creutzfeldt-Jakob disease patient into another human or experimental animal can initiate the pathogenic process in the recipient. These infectious forms of prion protein are called prions. Human prion diseases include fatal insomnia; kuru; Gerstmann-Straussler-Scheinker syndrome; and variant, familial and sporadic CJD. Sporadic CJD is the most common human prion disease, affecting about one in one million people annually worldwide. Other prion diseases include scrapie in sheep; chronic wasting disease in deer, elk and moose; and bovine spongiform encephalopathy (BSE), or mad cow disease, in cattle.

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Racial Differences in Plasma Biomarker May Partially Explain Stroke Disparities

MedicalResearch.com Interview with:

Pankaj Arora MD, FAHA Assistant Professor, Cardiology Division University of Alabama at Birmingham Section Editor, Circulation: Cardiovascular Genetics American Heart Association

Dr. Arora

Pankaj Arora MD, FAHA
Assistant Professor, Cardiology Division
University of Alabama at Birmingham
Section Editor, Circulation: Cardiovascular Genetics
American Heart Association 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Natriuretic peptides are hormones produced by the heart in response to increased wall stress in the atria and ventricles. It is well known that blacks have increased prevalence of cardiovascular disease which contributes to racial disparities in outcomes.

In the current work, we tested the hypothesis that black race is a natriuretic peptide deficiency state using a stratified random cohort of 4,415 participants selected from the REGARDS study (a national population-based cohort study evaluating racial and geographic disparities in stroke in US adults aged ≥45 years of age or older). Next, we looked for published results on the percentage difference in N-terminal proB-type NP (NTproBNP) levels by race in participants free of cardiovascular disease from other population cohorts. Lastly, we explored whether association of natriuretic peptides with all-cause mortality and CV mortality in apparently healthy individuals from REGARDS differs by race.

We found that in multivariable adjustment, NTproBNP levels were up to 27% lower in black individuals as compared with white individuals in the REGARDS study. We pooled our results and found that in meta-analysis of the 3 cohorts, NTproBNP levels were 35% lower in black individuals than white individuals (more than 13,000 individuals in total). Lastly, we found that the higher NTproBNP levels were associated with higher incidence of all-cause mortality, and cardiovascular mortality in healthy blacks and white individuals, and this association did not differ by race.

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Nonphysician Clinicians Provide Wide Variety of Dermatology Services To Medicare Patients

MedicalResearch.com Interview with:

Adewole Adamson, MD, MPP Department of Dermatology UNC – Chapel Hill North Carolina

Dr. Adamson

Adewole Adamson, MD, MPP
Department of Dermatology
UNC – Chapel Hill North Carolina 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Nurses practitioners and physician assistants, collectively known as non-physician clinicians (NPCs), provide many dermatology services, some which are billed for independently. Little is known about the types of these services provided. Even less is known about where these independently billed services are provided. Given that there is a purported shortage of dermatologists in the United States (US),  NPCs have been suggested as way to fill in the gap.

In this study, we found that NPCs independently billed for many different types of dermatology associated procedures, including surgical treatment of skin cancer, flaps, grafts, and billing for pathology. Most of these NPCs worked with dermatologists. Much like dermatologists, NPCs were unevenly distributed across the US, concentrating mostly in non-rural areas.

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Radiologic Findings Can Be Key In Identifying Intimate Partner Violence

MedicalResearch.com Interview with:
“IMGP6403_qtu-no-violence” by Rae Allen is licensed under CC BY 2.0
Elizabeth George, MD
PGY-4 Radiology Resident
Brigham and Women’s Hospital
Dr. Bharti Khurana MD
Clinical Fellow, Harvard Medical School and
Assistant Director, Emergency Radiology
Director, Emergency Musculoskeletal Radiology
Program Director, Emergency Radiology Fellowship
Assistant Professor, Harvard Medical School


MedicalResearch.com: What is the background for this study? What are the main findings?

Response: According to the CDC, 1 in 3 women in the United States are victims of abuse by their intimate partner. Despite the US Preventive Services Task Force recommendations, intimate partner violence (IPV) screening is still not widely implemented and IPV remains very prevalent and often under-recognized.

The goals of this study are to increase the awareness among physicians about this public health problem and to elucidate the potential role of imaging in the identification of these patients. In fact, there is a striking disparity in the literature on the role of imaging in identifying non-accidental trauma in children compared to intimate partner violence.

The common patterns of injury we identified in this population were soft tissue injuries (swelling, hematoma or contusion) followed by extremity fractures, which often involve the distal upper extremities, suggesting injury from defensive attempts. Other common injuries were facial fractures, which represent an easily accessible site for inflicting trauma, and pregnancy failure. Since radiologists have access to both current and prior radiological studies of these patients, they could play a critical role by putting the pieces together in identifying victims of IPV.

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Sex Differences In Body Fat Composition Predictive of Cardiometabolic Risk Profile

MedicalResearch.com Interview with:

Miriam Bredella, MD Associate Professor of Radiology, Harvard Medical School Department of Radiology Massachusetts General Hospital Boston, MA 02114

Dr. Bredella

Miriam Bredella, MD
Associate Professor of Radiology
Harvard Medical School
Department of Radiology
Massachusetts General Hospital
Boston, MA 02114

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that body composition differs between men and women, with women having proportionally more fat and men more muscle mass.

But not the amount of fat but its distribution is an important determinant of cardiometabolic risk, with certain ectopic fat depots, such as visceral adipose tissue, fat within muscle cells – intramyocellular (IMCL), and liver fat, being more detrimental than others, such as femorogluteal subcutaneous adipose tissue.

We therefore wanted to study sex differences in body composition and cardiometabolic risk in men and women with obesity.

We found that at the same BMI, men had relatively higher visceral adipose tissue, IMCL, liver fat, muscle and lean mass, while women higher percent fat mass and higher subcutaneous adipose tissue. This female anthropometric phenotype was associated with a better cardiometabolic risk profile at similar BMI compared to men. However, ectopic fat depots were more strongly associated with adverse cardiometabolic risk factors in women compared to men

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Rapid Increase in ER Visits For Young Girls With Self-Inflicted Injuries

MedicalResearch.com Interview with:

Dr. Melissa C. Mercado PhD, MSc, MA Behavioral scientist Division of Violence Prevention National Center for Injury Prevention and Control CDC

Dr. Mercado

Dr. Melissa C. Mercado PhD, MSc, MA
Behavioral scientist
Division of Violence Prevention
National Center for Injury Prevention and Control
CDC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Suicide ranks as the 10th leading cause of death for all age groups combined and has been among the top 12 leading causes of death since 1975 in the U.S. In 2015, across all age groups, suicide was responsible for 44,193 deaths in the U.S., which is approximately one suicide every 12 minutes.

Suicide was the second leading cause of death among U.S. youth aged 10-24 years in 2015. Self-inflicted injury is one of the strongest risk factors for suicide.

This study examined trends in non-fatal self-inflicted injuries treated in hospital emergency departments (EDs) among youth aged 10 to 24 years in the United States from 2001-2015.  The overall weighted age-adjusted rate for this group increased by 5.7% annually during the 2008 to 2015 period.  Age-adjusted trends for males overall and across age groups remained stable throughout 2001-2015.  However, rates among females increased significantly, by 8.4% annually. The largest increase among females was observed among those aged 10-14 years, with an increase of 18.8% annually from 2009 to 2015.

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Some Cancer Drugs May Also Treat Hypertension

MedicalResearch.com Interview with:

Anton Wellstein, MD PhD Professor Oncology & Pharmacology Georgetown University Medical School Associate Director for Basic and Translational Science Lombardi Comprehensive Cancer Center Washington DC

Dr. Wellstein

Anton Wellstein, MD PhD
Professor Oncology & Pharmacology
Georgetown University Medical School
Associate Director for Basic and Translational Science
Lombardi Comprehensive Cancer Center
Washington DC

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Tumor angiogenesis and signaling by growth factors such as Fibroblast growth factors (FGFs) are targets for the treatment of cancer. Targeting some of these factors will alter blood pressure. We show that FGF activation in an animal model can cause hypertension. We show that the hypertension is driven by sensitization of resistance vessels to the vasoconstrictor angiotensin II. We propose that drugs used to target FGF pathway signaling in cancer could be useful to treat hypertension.

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Diabetic Atherosclerosis Management Can Be Personalized Using Coronary Artery Calcium Score

MedicalResearch.com Interview with:
Dr. MalikDr. Shaista Malik MD PhD MPH
Director of Samueli Center For Integrative Medicine
Assistant Professor, School of Medicine
University of California, Irvine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Having diabetes has been considered to be a risk equivalent to already had a myocardial infarction for predicting future cardiovascular events.  We were interested in testing whether further risk stratification in those with diabetes and metabolic syndrome, using coronary artery calcium (CAC), would result in improved prediction of cardiovascular events.

We found that CAC score was associated with incident coronary heart disease and cardiovascular disease more than a decade after the scoring was performed.  We also found that even after we controlled for the duration of diabetes (of 10 years or more), insulin use, or hemoglobin A1c level, coronary artery calcium remained a predictor of cardiovascular events.

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Micro RNAs in Saliva May Predict Severity of Concussion Injuries

MedicalResearch.com Interview with:

Dr. Steven D. Hicks,  M.D., Ph.D Penn State Health

Dr. Hicks

Dr. Steven D. Hicks,  M.D., Ph.D
Penn State Health

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Previous research has shown that small epigenetic molecules called microRNAs are altered in the blood after a traumatic brain injury. Our own pilot research showed that microRNAs were also changed in the saliva after brain injury and that some of these changes mirrored changes in cerebrospinal fluid. In this study we investigated whether salivary microRNA patterns after a concussion could be used to predict the duration and character of symptoms one month after injury.

We found that levels of five microRNAs predicted presence of symptoms one month later with greater accuracy (~85%) than standard surveys of symptom burden (~65%). Interestingly, one of the predictive salivary microRNAs (miR-320c) targets pathways involved in synaptic plasticity and was significantly correlated with attention difficulties one month after concussive injury.   Continue reading

NOACs For Atrial Fib Anticoagulation May Have Lower Risk of Kidney Side Effects

Atrial Fibrillation - Wikipedia image

Normal rhythm tracing (top) Atrial fibrillation (bottom) Wikipedia

Interview with:
Dr Xiaoxi Yao PhD
Assistant Professor
Researcher
Mayo Clinic

What is the background for this study? What are the main findings?

Response: Lifelong oral anticoagulation, either with warfarin or a non-vitamin K antagonist oral anticoagulant (NOAC), is indicated for stroke prevention in most patients with atrial fibrillation (AF). Emerging evidence suggests that NOACs may be associated with better renal outcomes than warfarin.

The study found renal function decline is common among patients with atrial fibrillation treated with oral anticoagulants. NOACs, particularly dabigatran and rivaroxaban, may be associated with lower risks of adverse renal outcomes than warfarin.

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Collaborative Effort Allows Oversight of Antipsychotic Medications in Medicaid Children

MedicalResearch.com Interview with:

Julie M. Zito, PhD Professor of Pharmacy and Psychiatry University of Maryland, Baltimore Pharmaceutical Health Services Department Baltimore, MD 21201

Dr. Zito

Julie M. Zito, PhD
Professor of Pharmacy and Psychiatry
University of Maryland, Baltimore
Pharmaceutical Health Services Department
Baltimore, MD 21201 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The growth of antipsychotic use in children, mainly for the treatment of behavior, has been of increasing concern in recent years. Clinical safety issues (Burcu et al. 2017) and government reports on overuse in the treatment of poor and foster care children (GAO, 2017; 2012) motivated our assessment of peer review programs. These programs are a relatively new approach to Medicaid oversight intended to monitor and assure clinical appropriateness of second generation antipsychotics in children. Critically important is the fact that most antipsychotic use is for child behavioral problems which are off-label conditions, i.e. without sufficient evidence of effectiveness or safety.

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Common Air Pollutants Associated With Increased Risk of Pregnancy Loss

MedicalResearch.com Interview with:
“Cairo Air Pollution with smog - Pyramids1” by Nina Hale is licensed under CC BY 2.0Pauline Mendola, PhD

Investigator
Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH
Bethesda, MD  20892

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We compared ambient air pollution levels at the residences of couples who were trying to get pregnant and estimated the risk of pregnancy loss associated with common pollutants. No prior studies have been done in the United States and most studies are retrospective, looking back in time, and asking couples to report on their reproductive outcomes. Without detailed prospective follow-up, early pregnancy losses that occur before entry into care (i.e., before women are aware that they are pregnant) are often missed. In contrast, we studied 501 couples in the Longitudinal Investigation of Fertility and the Environment (LIFE) study who were enrolled before pregnancy and followed until they became pregnant or tried for 12 months without a pregnancy. Using this prospective data, we found that both ozone and fine particles (PM2.5) were associated with a 12-13% increased risk of early pregnancy loss.

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People Who Regularly Eat Nuts Have Lower Risk of Heart Disease

MedicalResearch.com Interview with:
“Nuts” by fdecomite is licensed under CC BY 2.0
Marta Guasch-Ferre, PhD
Research Fellow
Department of Nutrition. Harvard TH Chan School of Public Health
655 Huntington Ave, Building 2
Boston, Ma, 02115 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Although previous evidence has shown that frequent nut consumption is associated with reduced cardiovascular risk factors including dyslipidaemia, type 2 diabetes and metabolic syndrome; as well as with lower risk of coronary heart disease (CHD); most of the previous prospective studies have focused on total nut consumption in relation to the risk of CVD. However, the associations between peanut butter and specific types of nuts, such as peanuts and walnuts, with major cardiovascular events, and specifically the relation with stroke were unclear. Of note, because the nutritional composition of peanuts and walnuts differs from other nuts, it was of particular interest to evaluate the health effects of specific types of nuts. Therefore, our main aim was to look at several types of nuts including total nut consumption, peanuts, walnuts, and tree nuts.

Briefly, in three large prospective cohorts with up to 32 years of follow-up, people who regularly eat nuts, including peanuts, walnuts and tree nuts, have a lower risk of developing cardiovascular disease or coronary heart disease compared to people who never or almost never eat nuts. We found a consistent inverse association between total nut consumption and total cardiovascular disease (14% lower risk for those consuming nuts five or more times per week) and coronary heart disease (20% lower risk).

Also, after looking at individual nut consumption, eating walnuts one or more times per week was associated with a 19 percent lower risk of cardiovascular disease and 21 percent lower risk of coronary heart disease. Participants who ate peanuts or tree nuts two or more times per week had a 15 percent and 23 percent, respectively, lower risk of coronary heart disease compared to those who never consumed nuts.

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Database Analyses May Find Supplemental Uses For Established Drugs In Cost-Effective Manner

MedicalResearch.com Interview with:

Michael Fralick, MD FRCPC Research Fellow at the Division of Pharmacoepidemiology and Pharmacoeconomics Harvard University and General Internist at the University of Toronto

Dr. Fralick

Michael Fralick, MD FRCPC
Research Fellow at the Division of Pharmacoepidemiology and Pharmacoeconomics
Harvard University and
General Internist at the University of Toronto

MedicalResearch.com: What is the background for this study?

Response: Manufacturers of Food and Drug Administration (FDA)-approved prescription drugs often apply for additional indications based on randomized trials. “Real-world” data based on a medication’s actual use and outcomes in routine settings of care might help to inform decision-making regarding such supplemental indications.

MedicalResearch.com: What are the main findings?

Response:  In this non-randomized study we were able to replicate the results of the randomized trial that established the supplemental indication for telmisartan using data from a US healthcare database (insurance claims data) available at the time the randomized trial was completed.

We were also able to confirm the known decreased risk of angioedema with telmisartan compared to ramipril.

MedicalResearch.com: What should readers take away from your report?

Response: If done selectively and with principled methodologies, it might be feasible to use non-randomized real-world data to provide supportive evidence in establishing supplemental drug indications. To improve the validity of the studies, they should ideally be registered prior to them starting.

MedicalResearch.com: Is there anything else you would like to add?

Response: We used real-world data to recreate both the benefits and the harms found in a randomized controlled trial. The randomized trial costed 10s of millions of dollars and took over 7 years to complete. By contrast, our study took a few months to complete and was a small fraction of the cost of the randomized trial.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Michael Fralick, Aaron S. Kesselheim, Jerry Avorn, Sebastian Schneeweiss. Use of Health Care Databases to Support Supplemental Indications of Approved Medications. JAMA Intern Med. Published online November 20, 2017. doi:10.1001/jamainternmed.2017.3919

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

miLOOP Uses Minimal Energy To Encapsulate and Remove Cataracts

MedicalResearch.com Interview with:

Sean Ianchulev, MD MPH Chief Medical Officer VP of Medical Affairs and Business Development Transcend Medical 

Dr. Ianchulev

Sean Ianchulev, MD MPH
Chief Medical Officer
VP of Medical Affairs and Business Development
Transcend Medical 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Similar to MIGS stent technology for glaucoma, MiLOOP is a an application of micro-interventional technology for cataract surgery – allows the fragmentation of the lens with simple micro-interventional pen-like device which does not require complex, capital-intense phaco-emulsification…also it does not require vibrational energy

MedicalResearch.com: What should readers take away from your report?

 Iantech introduces a micro-­interventional devices designed to deliver energy-­free endocapsular lens fragmentationResponse: That after 50 years of conventional phacoemulsification cataract technology, new breakthrough micro-interventional approaches are on the horizon.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Future studies will evaluate whether micro-interventional approaches for cataract surgery can replace phacoemulsification equipment altogether.

Any disclosures?

I am the founder and Chairman of the company.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation: Ianchulev S. Microinterventional cataract surgery. Presented at American Academy of Ophthalmology annual meeting; Nov. 11-14, 2017; New Orleans. 

 

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

Weight Loss Procedures Can Double Blood Alcohol Absorption

MedicalResearch.com Interview with:

“Alcohol” by Takahiro Yamagiwa is licensed under CC BY 2.0


Marta Yanina Pepino PhD

Department of Food Science and Human Nutrition
College of Agricultural, Consumer and Environmental Sciences
University of Illinois
Urbana, IL 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is not the first to look at whether sleeve gastrectomy affects alcohol absorption and metabolism. Before our study, there were three published studies in the literature on this issue. However, findings from these studies were discrepant. Two of the studies found that sleeve gastrectomy did not affect blood alcohol levels and one of the studies did found that peak blood alcohol levels were higher when people drink after having a sleeve gastrectomy. All these three studies used a breathalyzer to estimate blood alcohol levels.

Our study tested the following two related hypothesis.

First, that similar to Roux-en-Y- gastric bypass (RYGB), sleeve gastrectomy accelerates alcohol absorption, which cause peak blood alcohol levels to be higher and much faster than before surgery. Because the breathalyzer requires a 15 min of waiting time between drinking the last sip of alcohol and the time that you can read a good estimate of blood alcohol levels from the breath, we hypothesized that the breathalyzer was not a good technique to estimate peak blood alcohol levels in people who may reach a peak blood alcohol level before those 15 min have passed, such as people who underwent sleeve gastrectomy or RYGB.

We found these two hypothesis to be truth:

1) Sleeve gastrectomy, similar to RYGB, can double blood alcohol levels; and

2) The breathalyzer technique is invalid to assess effects of gastric surgeries on pharmacokinetics of ingested alcohol (it underestimate blood alcohol levels by ~27% and it may miss peak blood alcohol levels).

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Advanced Directive Forms Rarely Completed by Patients Seen For Palliative Care Consult

MedicalResearch.com Interview with:

Kara Bischoff, MD Assistant Clinical Professor, Hospital Medicine & Palliative Care Director of Quality Improvement for the Palliative Care Service UCSF Department of Medicine

Dr. Bischoff

Kara Bischoff, MD
Assistant Clinical Professor, Hospital Medicine & Palliative Care
Director of Quality Improvement for the Palliative Care Service
UCSF Department of Medicine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Care planning, which we define as including both advance care planning and goals of care discussions, are a common need in seriously ill patients and a key function of palliative care teams.

However, few studies have looked at how often and how care planning is being done by inpatient palliative care teams throughout the United States, and similarly few studies have examined the precise impact of these care planning activities. Therefore, using data from a large quality improvement registry in palliative care called the Palliative Care Quality Network, we examined:

1) the characteristics of hospitalized patients who are referred to inpatient palliative care consult services,

2) the activities that occurred during those inpatient palliative care consults, and

3) the outcomes that resulted.

In looking at data from 73,145 patients who referred for an inpatient palliative care consult, we found that care planning was the most common reason for inpatient palliative care consultation, requested for 71.9% of patients who were referred to palliative care. Further, care planning needs were found in more than half (58%) of palliative care patients even when the consult was requested for reasons other than care planning. Patients referred to palliative care for care planning were somewhat older than patients referred for other reasons, they were less likely to have cancer, and were more often full code at the time of referral. Through care planning conversations, palliative care clinicians frequently identified surrogates and clarified patients’ preferences for life-sustaining treatments (including code status). For instance, 31% more patients chose a code status of DNR/DNI after a conversation with the palliative care team.

However, we also found that legal forms such as advance directives and Physician Orders for Life-Sustaining Treatments (POLST) forms were completed for just 3.2% and 12.3% of the patients see by palliative care teams, respectively. This highlights an important quality gap in need of improvement.

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Should Bleach Baths Be Used To Treat Eczema?

MedicalResearch.com Interview with:

Dr. Jonathan L. Silverberg MD PhD MPH Assistant Professor in Dermatology Medical Social Sciences and Preventive Medicine Northwestern University, Chicago, Illinois

Dr. Jonathan Silverberg

Dr. Jonathan L. Silverberg MD PhD MPH
Assistant Professor in Dermatology
Medical Social Sciences and Preventive Medicine
Northwestern University, Chicago, Illinois

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Bleach baths have become widely used in clinical practice for the treatment of atopic dermatitis (AD). However, there have been conflicting results about the efficacy of bleach baths across different studies. We performed a systematic review and meta-analysis to determine whether bleach baths are consistently effective in decreasing the severity of atopic dermatitis.

Bleach baths were shown to be effective at reducing AD severity in all 4 of the included studies. However, when comparing bleach baths vs. regular water baths, only 2 found significantly greater decreases in atopic dermatitis severity with bleach baths, 1 found greater decreases with water baths, and 1 found no significant differences. There were 15 different severity assessment evaluations across studies at 4 weeks: only 3 assessments demonstrated that bleach baths were more effective than water baths, 11 reported no difference, and 1 reported regular water baths to be more effective. In pooled meta-analyses, there were no significant differences observed between bleach vs water baths at 4 weeks vs baseline for the Eczema Area and Severity Index or body surface area. Finally, there were no differences of Staphylococcus aureus density, other bacteriological assessments or skin infection rates between bleach vs. water baths.

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Sending That Quick Text While Driving Can Kill You

MedicalResearch.com Interview with:
“texting and driving” by frankieleon is licensed under CC BY 2.0Ole J. Johansson

Junior researcher
Master’s in social psychology
Institute of Transport Economics

MedicalResearch.com: What is the background for this study?

Response: Many countries have bans on driving while distracted and would fine drivers for texting while driving. Furthermore, people mostly know about the dangers of not paying attention to the traffic. Still, many people do engage in distracting behaviors. Thus, in this study, I wanted to examine:

a) Who are more likely to engage with distractors?

b) Is there an easy way to help people avoid distractions?

From these two points, we developed the study to engage with distracted driving from a psychological and scientific point of view.

Specifically using the theory of planned behavior and the big five to answer point a) and implementation intentions to answer point b).

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Having a Dog May Help You Live Longer

MedicalResearch.com Interview with:

Tove Fall PhD Senior author of the study Associate Professor in Epidemiology Department of Medical Sciences and the Science for Life Laboratory Uppsala University.

Dr. Fall

Tove Fall PhD
Senior author of the study
Associate Professor in Epidemiology
Department of Medical Sciences and the Science for Life Laboratory
Uppsala University

MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Loneliness and sedentary lifestyle are two major risk factors for cardiovascular disease and mortality, but are notoriously difficult to prevent in the general population.

Previous studies have shown that dogs may serve as a strong motivator for daily exercise, provide substantial social support and have a positive effect on the owner’s gut microbiome. The effects of pet dogs on health outcomes in the general population are largely unknown.

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Children With Eczema and Food Allergies At Increased Risk of Developing Asthma

MedicalResearch.com Interview with:
“Eczema” by NIAID is licensed under CC BY 2.0Malcolm R. Sears, MB ChB

Firestone Institute for Respiratory Health
St Joseph’s Healthcare and McMaster University
Ontario Canada. 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The Canadian Healthy Infant Longitudinal Development (CHILD) Study was initiated in 2008, funded by AllerGen NCA and CIHR, to determine root causes of allergy and asthma.

We recruited 3623 pregnant mothers in 4 centers across Canada and are following 3495 eligible children from pregnancy to age 5 years.

In this paper we describe some of the findings in early childhood, namely that children who develop skin conditions generally called eczema or atopic dermatitis, who are also sensitized to food allergens (milk, egg, peanut) at 1 year are at high risk of developing subsequent asthma, whereas those with these skin conditions but not sensitized are not at such risk.

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MedImmune’s MEDI9197 Activates Immune System To Fight Tumors

MedicalResearch.com Interview with:

Dr. Koustubh Ranade, Vice President of Research & Development Translational Medicine MedImmune

Dr. Ranade

Dr. Koustubh Ranade, PhD
Vice President of Research & Development Translational Medicine
MedImmune

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: In a healthy person, abnormal cells including cancer cells are typically detected and destroyed by the immune system in response to danger signals activated by the abnormal cells. However, some solid tumors avoid triggering danger signals, and thus the immune system cannot recognize and destroy cancer cells, permitting tumor growth. To help activate the patient’s immune system to fight these “hidden” cancer cells, MedImmune scientists have developed MEDI9197, a TLR 7/8 agonist, to trigger the needed danger signals.

Our latest data from the Phase 1 study of MEDI9197 demonstrated that through intratumor injection, the therapy binds to TLR7 and TLR8 receptors and activates dendritic cells, which call in other immune cells to fight the tumor.

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PTK6 Inhibitors May Target Endocrine Therapy-Resistant ER+ Breast Cancer

MedicalResearch.com Interview with:

Hanna Irie MD PhD Assistant Professor Oncology Mount Sinai Health System 

Dr. Irie

Hanna Irie MD PhD, senior author
Assistant Professor of Medicine
(Hematology and Medical Oncology) and Oncological Sciences at The Tisch Cancer Institute,
Icahn School of Medicine at Mount Sinai

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study identified PTK6 as a critical gene regulating survival of ER+ breast cancer cells.

PTK6 inhibition also suppresses growth and survival of ER+ breast cancer cells that are resistant to the effects of therapies commonly used to treat patient ER+ breast cancers, making PTK6 an attractive candidate therapeutic target for these resistant cancers.

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Cellular Protein Nrf1 Protects Against Fatty Liver

MedicalResearch.com Interview with:

Gokhan S. Hotamisligil MD PhD

Dr. Hotamisligil

Gokhan S. Hotamisligil MD PhD
J.S. Simmons Professor of Genetics and Metabolism
Chair, Department of Genetics and Complex Diseases
Department of Genetics and Complex Diseases
Department of Nutrition
Harvard Stem Cell Institute

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Cholesterol is often considered a ‘bad’ nutrient, as it has been strongly linked to a cluster of metabolic diseases. In reality however, cholesterol is absolutely vital for the health of all animal cells, serves as an essential building block for all membranes and precursor for essential molecules.  It usually only becomes toxic when cells are exposed to high levels or free forms of cholesterol or when it is stored in excess.

The reasons why cholesterol over-accumulates or causes excessive damage in cells of some people is not entirely clear, as cells are normally should be able to remove such excesses, and there remains key mechanistic gaps in our understanding of how cells control the molecular process of sensing excess cholesterol, engage ways of removal and launch countermeasures to defend their integrity. Filling this gap may reveal a new path toward alleviating the burden of cholesterol-related diseases.

To this end, we identified a new signal pathway mediated by a protein called Nrf1, which enables cells to know when to remove cholesterol, thereby preventing excess cholesterol storage. We show that Nrf1 directly senses cholesterol in a strategic subcellular compartment called the endoplasmic reticulum and coordinates an adaptive and defensive responses that protects the cells and promotes the removal of cellular cholesterol. Continue reading

Allergan’s VRAYLAR (carprazine) Receives FDA Approval For Maintenance Treatment of Schizophrenia

MedicalResearch.com Interview with:

Dr. David Nicholson PhD EVP and Chief R&D Officer Allergan

Dr. Nicholson

Dr. David Nicholson PhD
EVP and Chief R&D Officer
Allergan

Discusses Allergan’s announcement that:
New Data Shows Long-Term VRAYLAR Therapy Delayed Time to Relapse Compared to Placebo Over the Course of up to 72 Weeks and has received FDA approval for the Maintenance Treatment of Schizophrenia

MedicalResearch.com: What is the background for this FDA approval?

Response: As many clinicians know, schizophrenia is among one of the most challenging mental health disorders to manage – due to the complexity of patient symptoms, varying response to treatment and high rates of relapse. Schizophrenia requires long-term medication management, and without maintenance treatment, 60 – 70% of schizophrenia patients relapse within one year.

The approval of Vraylar (carprazine) for the maintenance treatment of schizophrenia was based upon the results of a clinical trial, which found long-term cariprazine therapy delayed time to relapse compared to placebo over the course of up to 72 weeks.

MedicalResearch.com: What does this extended indication mean for people living with schizophrenia? 

Response: Schizophrenia affects about 2.4 million American adults, and there remains serious unmet needs in the treatment of schizophrenia. The differences in how patients with schizophrenia respond to treatment underscore the importance of having more treatment options available. With its proven efficacy and well-characterized safety profile, cariprazine provides another treatment option for patients and clinicians. This study demonstrates cariprazine efficacy in the long-term (i.e., maintenance) treatment of schizophrenia.

MedicalResearch.com: What should readers take away from this announcement?

Response: As a chronic disease and disabling disorder, schizophrenia requires long-term medication management. Cariprazine is a safe and effective treatment for schizophrenia in both the short and long-term management of the illness. 

MedicalResearch.com: Is there anything else you would like to add about this FDA approval and what it means for the mental health community?

Response: On behalf of Allergan as Chief Research & Development Officer at the company, we are pleased that the FDA has recognized the benefits of cariprazine for maintenance treatment of adults with schizophrenia. This approval demonstrates our continued investment in cariprazine, as well as our commitment to developing treatments that address unmet needs facing people living with mental illness. Additionally, VRAYLAR is also approved in the U.S. in adults for the acute treatment of schizophrenia and acute treatment of manic or mixed episodes of bipolar I disorder.

David Nicholson is the Chief R&D Officer, and has served in this role since March 2015. Dr. Nicholson joined the company (then Actavis) as Senior Vice President, Global Brands R&D in August 2014. He has been in research and development in the pharmaceutical industry since 1978.

Previously, he served as Chief Technology Officer and EVP, R&D for Bayer CropScience from March 2012 to August 2014; Senior Vice President of Licensing and Knowledge Management at Merck from 2009 to December 2011; and Senior Vice President, responsible for Global Project Management and Drug Safety at Schering-Plough from 2007 to 2009. From 1988 to 2007, Dr. Nicholson held various leadership positions at Organon, where he most recently served as Executive Vice President, R&D and was a member of the company’s Executive Management Committee.

Dr. Nicholson earned his B.Sc. from the University of Manchester and his Ph.D. from the University of Wales.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Allergan Receives FDA Approval For Use of VRAYLAR™ (cariprazine) in the Maintenance Treatment of Schizophrenia

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

What Impact Have State-Level Laws Had on Marijuana Use?

MedicalResearch.com Interview with:

MedicalResearch.com Interview with: Christine Mauro PhD Assistant Professor Biostatistics Columbia University Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.  We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003). There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.    MedicalResearch.com: What should clinicians and patients take away from your report? Response:  The readers should take away several things.  First, despite men being more likely to use marijuana than women are in all age groups, there were relatively few gender differences in terms of the impact of medical marijuana on marijuana use. Second, we found no evidence of an effect of medical marijuana law enactment in any marijuana use outcome for both men and women aged 12-17.  Lastly, we did see an increase in both past-month use and daily use among past-year users in both men and women aged 26+ after enactment, but no changes in past year marijuana used disorder.    MedicalResearch.com: What recommendations do you have for future research as a result of this study?  Response: Because most states in our sample more recently passed medical marijuana laws, it is possible that not enough time has elapsed to observe meaningful and significant changes in Marijuana Use Disorder. Given the impact Marijuana Use Disorder may have on individuals, families, and society, the prevalence of Marijuana Use Disorder should continue to be monitored regularly.   Second, there is considerable variation across provisions included in different states’ medical marijuana laws; some aspects, such as allowances on home cultivation or dispensaries, might have a role in changes in several health outcome indicators.  In addition, eight states have now legalized recreational marijuana, which may also have an impact on marijuana use outcomes over time. Future analyses should account for this variability in marijuana related policies.   MedicalResearch.com: Is there anything else you would like to add? Response: As marijuana use becomes more prevalent, monitoring state-wide trends in marijuana use by age and gender is important for public health planning. In particular, efforts to prevent and limit injury that may be associated with specific activities, such as driving, may be needed as daily marijuana use increases among adults. Downstream effects, either positive or negative, of a growing proportion of the adult population reporting daily marijuana use in states with medical marijuana laws warrants further attention. Disclosure: This work was supported by the National Institutes of Health, National Institute on Drug Abuse (grant R01 DA037866 to S. S. Martins).   MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.  Citation: Christine M. Mauro, Paul Newswanger, Julian Santaella-Tenorio, Pia M. Mauro, Hannah Carliner, Silvia S. Martins. Impact of Medical Marijuana Laws on State-Level Marijuana Use by Age and Gender, 2004–2013. Prevention Science, 2017; DOI: 10.1007/s11121-017-0848-3   Note:  Content is Not intended as medical advice.  Please consult your health care provider regarding your specific medical condition and questions.

Dr. Mauro

Christine Mauro PhD
Assistant Professor Biostatistics
Columbia University Medical Center 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: As of November 2016, 28 states have legalized medical marijuana. Several previous studies have found an increase in use for adults after legalization, but not for adolescents.

We wanted to examine whether these age-specific findings varied by gender.  Consistent with past findings, we found past-month marijuana use did not increase after enactment of medical marijuana laws in men or women ages 12-25. Among people 26+, past-month marijuana use increased for men from 7.0% before to 8.7% after enactment (+1.7%, p<0.001) and for women from 3.1% before to 4.3% after enactment (+1.1%, p=0.013). Daily marijuana use also increased after enactment in this age group for both genders (men: 16.3% to 19.1%, +2.8 %, p=0.014; women: 9.2% to 12.7%, +3.4%, p=0.003).

There were no statistically significant increases in past-year Marijuana Use Disorder prevalence for any age or gender group after medical marijuana law enactment.

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Testicular Cancer Stem Cells Highly Sensitive To Chemotherapy, Resulting In High Cure Rates

MedicalResearch.com Interview with:

 Credit: Tim Pierpont, Cornell University

A low magnification image of a germ cell tumor, called a teratocarcinoma, from a new mouse model developed to study testicular cancer. A cluster of cancer stem cells, termed embryonal carcinoma, is shown at higher magnification at the bottom.

 

Amy M. Lyndaker, Ph.D.
Assistant Professor of Biology
Division of Mathematics and Natural Sciences
Elmira College
This work was completed when I was a Research Associate in the laboratory of
Dr. Robert S. Weiss at:
Department of Biomedical Sciences College of Veterinary Medicine
Cornell University Ithaca, NY

 

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There has been this puzzle in the field of cancer biology that testicular cancers, even after they have spread to the brain or the lungs, are often able to be cured with radiation and chemotherapy (think of Lance Armstrong, for instance), whereas the majority of cancers are not curable with similar treatments. We thought that this could be due to the unique properties of the cells from which the cancers are derived; testicular cancers arise from germ cells (which later go on to make sperm), whereas most cancers arise from somatic cells (body cells). We proposed that maybe the germ cells and somatic cells were hard-wired to respond differently to DNA damage, and that because of this, cancers derived from these two distinct types of cells might then respond differently to chemotherapies (which typically kill cancer cells by creating DNA damage).

To test this, we generated a novel genetic mouse model that develops cancers similar to the malignant testicular cancers seen in young men. We then used standard chemotherapies (cisplatin alone, or combined bleomycin/etoposide/cisplatin), and found that treatment with DNA-damaging chemotherapies specifically killed the cancer stem cells within the tumors. Thus, we were able to show that testicular cancers are curable with standard DNA-damaging chemotherapies because their stem cells are highly sensitive to DNA damage. This is in contrast to most cancers, where the cancer stem cells are refractory to treatment and are responsible for tumor recurrence and metastasis.

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Obsessive-Compulsive Disorder Associated With Educational Underachievment

MedicalResearch.com Interview with:

Ana Pérez-Vigil MD Department of Clinical Neuroscience Child and Adolescent Psychiatry Research Center Karolinska Institutet

Dr. Perez-Vigil

Ana Pérez-Vigil MD
Department of Clinical Neuroscience
Child and Adolescent Psychiatry Research Center
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Everyone who regularly works with persons who have obsessive-compulsive disorder (OCD) has seen that their patients often struggle with school work. It is not uncommon for these individuals to have poor school attendance and severe patients can be out of the education system altogether. This applies to persons of all ages, from school children to young adults who may be at university.

On the other hand there is a group of patients who, against all odds, working 10 times as hard as everybody else, manage to stay in education and eventually get a degree. So we have long suspected that OCD has a detrimental impact on the person’s education, with all the consequences that this entails (worse chances to enter the labour market and have a high paid job). But we did not really know to what extent OCD impacts education. So we wanted to know what is the actual impact of OCD on educational attainment using objectively collected information from the unique Swedish national registers. Previous work had been primarily based on small clinical samples from specialist clinics, using either self or parent report and cross-sectional designs. Previous work also tended not to control for important confounders such as psychiatric comorbidity or familial factors (genetic and environmental factors that could explain both OCD and the outcomes of interest).

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Bariatric Surgery Can Reduce Number Of Medications Needed To Control Blood Pressure

MedicalResearch.com Interview with:
“Blood Pressure” by Bernard Goldbach is licensed under CC BY 2.0Dr.
Carlos Aurelio Schiavon
Research Institute, Heart Hospital
São Paulo, Brazil 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obesity and hypertension are highly prevalent diseases and when they are associated,  cardiovascular risk is almost double over patients with obesity alone. 60-70% of hypertension in adults may be attributable to adiposity.

To address both problems, we designed the GATEWAY TRIAL to evaluate the efficacy of Gastric Bypass in the reduction of antihypertensive medications in obese patients using at least 2 medications at maximum doses.

After 1 year, results were very consistent. 83.7 % of the patients submitted to Gastric Bypass reduced at least 30% of the total number of medications maintaining a controlled blood pressure (<140/90 mm Hg) and 51% remitted from hypertension, defined by controlled blood pressure without medications. When we evaluated the reduction of the medication maintaining the Systolic blood pressure below 120 mmHg (SPRINT TARGET), 22.4% of the patients showed remission of hypertension.

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Increased Risk of Pregnancy Complications With Both Above and Below Normal BMI

MedicalResearch.com Interview with:
 <a href="https://www.flickr.com/photos/kit4na/8570833723">“Pregnancy”</a> by <i> <a href="https://www.flickr.com/people/kit4na/">Tatiana Vdb</a> </i> is licensed under <a href="https://creativecommons.org/licenses/by/2.0"> CC BY 2.0</a>Sarka Lisonkova, MD, PhD

Assistant Professor
Department of Obstetrics and Gynaecology
University of British Columbia.
Children’s and Women’s Health Centre
Vancouver, BC Canada 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We know that high BMI is associated with adverse birth outcomes for baby, including stillbirth, neonatal death, and others illnesses. However, less was known about the association with serious maternal morbidity.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Maternal pre-pregnancy BMI is important not only for baby’s health, but also for maternal health. The risk of majority of severe maternal complications, for example acute cardiac or pulmonary problems, increases with BMI above normal values. On the other side, women with BMI below-normal values also have increased risk of some complications, for instance, excessive bleeding before or after delivery that requires transfusion. However, maternal death​ or life-threatening complications are very rare, so the chance of experiencing such event is very low even for women who are obese.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Adopting a healthy lifestyle and reaching normal BMI before pregnancy is the best strategy for healthy pregnancy and optimal childbirth. For women who are underweight, overweight, or obese and already pregnant, it is important to strive for optimal weight-gain during pregnancy and good prenatal care. Modern obstetric care can prevent most severe maternal and infant morbidity by careful monitoring of maternal blood pressure and glucose level during pregnancy, and by timely obstetric interventions when maternal or baby conditions worsen. 

MedicalResearch.com: Is there anything else you would like to add?

Response: The epidemic of obesity in the industrialized countries is alarming. US data show that about 50% of pregnant women are now overweight or obese. Even though maternal death and severe morbidity are very rare, we will see more of these serious adverse events in the future if the trend in obesity continues. This will also put more strain on obstetric services and increase the need for obstetric interventions. High-risk mothers need to be closely monitored during pregnancy and deliver in higher-level hospitals with appropriate resources,  including, for example, availability of maternal-fetal medicine specialist and an intensive care unit.

No disclosures

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Lisonkova S, Muraca GM, Potts J, Liauw J, Chan W, Skoll A, Lim KI. Association Between Prepregnancy Body Mass Index and Severe Maternal Morbidity. JAMA. 2017;318(18):1777–1786. doi:10.1001/jama.2017.16191

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

 

 

 

 

 

 

No Clear Guidelines To Manage Pain After Surgical Procedures

MedicalResearch.com Interview with:
“Surgery” by mrpbps is licensed under CC BY 2.0
Sagar Patel MD
Facial Plastic Surgeon
Board Certified Otolaryngology, Head and Neck Surgeon
Facial Plastic Surgery Associates, Houston, Texas

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: While the majority of diverted opioids that are abused originate from pills prescribed for chronic conditions, with 214,000 rhinoplasties performed in the US in 2015, assessing opioid usage after rhinoplasty is an important view into prescription practices for acute pain after surgical procedures. Opioid use, pain control, and adverse effects were examined and opioid use was compared across patient demographic and surgical procedure characteristics, including rhinoplasty and septoplasty, open vs closed techniques, revision vs primary operations, reduction of turbinates, and use of osteotomies. Opioid use was self-reported as the number of prescribed tablets containing a combination of hydrocodone bitartrate (5 mg) and acetaminophen (325 mg) that were consumed. We them mathematically analyzed.

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Despite More A1C Testing, Diabetes Control Plateaus

MedicalResearch.com Interview with:
Saeid Shahraz, MD, PhD
Heller School of Social Policy and Management
Brandeis University
Waltham, Massachusetts 

MedicalResearch.com: What is the background for this study?

Response: Previous researchers had shown a significant improvement in diabetes control in the US between the years 1998 and 2010. We wanted to show if the betterment in diabetes control continued after then.

As previously, we measured hemoglobin A1C that shows the extent to which blood glucose level is under control.

Our main finding was that this upward improving trend plateaued for years after 2007 up to 2014, the last year for which we had data. We examined both genders, white and non-white populations as well as three age groups; young, middle age, and elderly population and results were the same: no change.

Overall, in 2007, 14% of patients with diabetes showed a poor diabetes control (Hemoglobin A1C more than 9%) ; in 2014, 15% of patients with diabetes fell within the category of poor diabetes control. 55% of the patients had a Good control of diabetes (Hemoglobin A1C less than 7%) in 2007; this measure was 54% in 2014.

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How Much Non-Invasive Testing Is Necessary In ER To Rule Out Heart Attack?

MedicalResearch.com Interview with:

David L. Brown, MD, FACC Professor of Medicine Cardiovascular Division Washington University School of Medicine St. Louis, MO 63110

Dr. Brown

David L. Brown, MD, FACC
Professor of Medicine
Cardiovascular Division
Washington University School of Medicine
St. Louis, MO 63110

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Approximately 10 million patients present to emergency rooms in the US annually for evaluation of acute chest pain.

The goal of that evaluation is to rule out the diagnosis of an acute heart attack. Imaging with coronary CT angiography and stress testing are not part of the diagnostic algorithm for acute heart attack.  Nevertheless many chest pain patients undergo some form of noninvasive cardiac testing in the ER. We found that CCTA or stress testing adding nothing to the care of chest pain patients beyond what is achieved by a history, physical examination, ECG and troponin test.

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Adherence to HIV Treatment May Protect Brain From Further Injury

MedicalResearch.com Interview with:

Ryan Sanford

Ryan Sanford

Ryan Sanford, MEng
Department of Neurology and Neurosurgery
Montreal Neurological Institute
McGill University, Montréal, Québec, Canada
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: With the introduction of combination antiretroviral therapy (cART) the outlook for HIV+ individuals has dramatically shifted from a fatal disease to a chronic manageable condition. However, HIV-associated neurocognitive disorders are still prevalent. The etiology of this dysfunction remains unknown. Previous work has reported progressive brain atrophy in HIV+ individuals with advanced disease and poor viral suppression, but it is unclear whether stable treatment and effective viral suppression can mitigate the progression of brain atrophy. To examine this issue, we followed well-treated HIV+ individuals with good viral suppression and well-matched controls, and assessed whether ongoing brain atrophy occurs over time.

The main finding in this study was the HIV+ participants had reduced brain volumes and poorer cognitive performance compared to the control group, but the changes in brain volumes and cognitive performance were similar between the groups.

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Sleep Apnea Increases Amyloid Load In Brain, A Hallmark of Alzheimer’s Disease

MedicalResearch.com Interview with:

Ricardo S Osorio MD Center for Brain Health Department of Psychiatry Center of Excellence on Brain Aging NYU Langone Medical Center New York, NY 10016, USA

Dr. Osorio

Ricardo S Osorio MD
Center for Brain Health
Department of Psychiatry
Center of Excellence on Brain Aging
NYU Langone Medical Center
New York, NY 10016, USA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was a study that was performed in a group of healthy normal elderly from the community that volunteered for studies on memory and aging.

The main findings were that sleep apnea was very common, in almost all cases undiagnosed, and that it was associated with a longitudinal increase in amyloid burden which is considered one of the hallmark lesions of Alzheimer’s disease

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LPA Gene Variant May Help Identify Increased Risk of Aortic Stenosis 

MedicalResearch.com Interview with:

Aortic Stenosis Blaus Image Wikipedia

Aortic Stenosis Blaus Image Wikipedia

Hao Yu Chen, MSc
Department of Medicine
McGill University
Montreal, Quebec, Canada
Senior author: George Thanassoulis, MD, MSc

MedicalResearch.com: What is the background for this study?

Response: Aortic stenosis, a narrowing of the main valve of the heart, is the most common type of valve disease in the US. Present in more than 2.5 million individuals in North America, aortic stenosis can lead to heart failure and death. However, there is little known about the causes of aortic stenosis and how it should be treated.

Previously, we have demonstrated that variants of the gene LPA are associated with the development of aortic stenosis. A better understanding of how this region contributes to aortic stenosis could identify higher-risk individuals and inform the development of new medical therapies for aortic stenosis.  Continue reading

Keyhole vs Open Surgery For Ruptured Abdominal Aortic Aneurysm

MedicalResearch.com Interview with:

ruptured Abdominal Aortic Aneurysm as seen on CT- Wikipedia James Heilman, MD

A ruptured abdominal aortic aneurysm  as seen on CT

 

 

Professor JT Powell PhD, MD, FRCPath
Faculty of Medicine,
Department of Surgery & CancerImperial College London

 

 

 

MedicalResearch.com: What is the background for this study?

Response: The mortality from ruptured abdominal aortic aneurysm (AAA) remains very high causing about 6000 deaths each year in the UK.  The only hope for survival is an emergency operation to repair the burst aorta.  Even so the mortality may be as high as 45% within a month of repair using open surgery.

It has been suggested that minimally invasive repair using keyhole or endovascular techniques would lower the mortality to about 25% within a month of repair.  However not all shapes of aorta are suitable for endovascular repair (also called EVAR).

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Children and Young Adults With Diabetes Have Increased Risk of Sudden Cardiac Death

MedicalResearch.com Interview with:
“Diabetes Test” by Victor is licensed under CC BY 2.0Jesper Svane

Medical student
The Heart Center, University Hospital Rigshospitalet
Copenhagen 

MedicalResearch.com: What is the background for this study?

Response: At the beginning of this research project, we were aware that persons with diabetes have an increased risk of death, which is partly explained by an increased risk of sudden cardiac death. However, previous studies on causes of death and mortality among young persons with diabetes, particularly type 2 diabetes, are sparse. Furthermore the incidence of sudden cardiac death among young persons with diabetes in a nationwide setting is unknown.

The main purpose of the study was to illuminate the risk of death and especially the risk of cardiac death among children/young adults with diabetes.

On a personal note, a friend of mine, who was healthy and fit, died suddenly a few years ago at the age of 19. This tragic death raised a lot of feelings as well as questions in me. When I got the chance to work with Dr. Lynge and Dr. Tfelt, I saw this as an opportunity to expand my knowledge of sudden cardiac death among the young. Furthermore, the opportunity of contributing to research in order to prevent these devastating events in the future was personally appealing to me.

I initiated the project together with Thomas Hadberg Lynge, MD, last year, with Jacob Tfelt-Hansen, MD, DMSc as supervisor. Both are experienced researchers within the field of sudden cardiac death. Dr. Tfelt-Hansen leads a very productive research group at Rigshospitalet, Copenhagen, whose main focus is arrhythmias and sudden cardiac death.

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AI Study Supports Association of Increased Coffee Consumption With Decreased CVD Risk

MedicalResearch.com Interview with:
Coffee being poured Coffee pot pouring cup of coffee.  copyright American Heart Association
Laura Stevens
University of Colorado
Aurora, CO

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:
We started with asking ourselves how we could better predict cardiovascular and stroke outcomes.  In an ideal world, we would be able to predict cardiovascular disease (CVD) and stroke with 100% accuracy long before the occurrence of the event.  The challenge here is there are so many potential risk factors, and testing each one using traditional methods would be extremely time consuming, and possibly infeasible.

Therefore, we used artificial intelligence to find potential risk factors that could be important for risk of CVD and stroke.  The results of this analysis pointed to consumption of coffee cups per day and the number of times red meat was consumed per week as being potentially important predictors of CVD.

We then looked into these findings further using traditional statistical analyses to determine that increased coffee consumption and red meat consumption appeared to be associated with decreased risk of CVD.  The study initially used data from the Framingham Heart Study (FHS) original cohort.

The findings from this data were then tested using data from 2 independent studies, the Cardiovascular Heart Study (CHS) and the Atherosclerosis Risk in Communities Study (ARIC), which both supported the association of increased coffee consumption with decreased CVD risk.

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Benefits of Hypertension Treatment Depends Somewhat on Starting Blood Pressure Level

MedicalResearch.com Interview with:

Blood pressure monitor reading 120/80 copyright American Heart Association

Blood pressure monitor reading 120/80
copyright American Heart Association

Dr. Mattias Brunström
Department of Public Health and Clinical Medicine
Umeå University,Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Current guidelines recommend a systolic blood pressure treatment target below 140 mm Hg for most people. Since the publication of SPRINT however, many have suggested guidelines should be changed, recommending further blood pressure lowering.

We performed a systematic review and meta-analysis of randomized clinical trials comparing different blood pressure targets or antihypertensive treatment verus placebo. We separated primary preventive trials from secondary preventive trials, and stratified primary preventive trials by mean baseline systolic blood pressure. The analyses included 74 trials, with in total > 300 000 participants. Interestingly, we found that treatment effect was dependent on baseline systolic blood pressure in people without previous CVD.

While primary preventive treatment reduced the risk of death and cardiovascular disease if systolic blood pressure was 140 mm Hg or higher, treatment effect was neutral if systolic blood pressure was below 140 mm Hg.

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Insurance Coverage, Tumor Types Linked to Black-White Survival Disparity Among Younger Colorectal Cancer Patients

MedicalResearch.com Interview with:

Helmneh M. Sineshaw, MD, MPH American Cancer Society Atlanta, GA 30303

Dr. Sineshaw

Helmneh M. Sineshaw, MD, MPH
American Cancer Society
Atlanta, GA 30303

MedicalResearch.com: What is the background for this study?

Response: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in both men and women in the United Sates. Although overall CRC incidence and mortality rates are decreasing in the United States, rates are increasing in the younger population. Notwithstanding these patterns, CRC incidence and mortality rates continue to be higher in blacks than in whites. Although black-white survival disparity among patients with colorectal cancer is well documented in the literature and multiple factors have been proposed as potential contributors, the contributions of differences in demographic characteristics, insurance type, comorbidity, tumor presentation, and treatment receipt to the racial disparity in survival among nonelderly CRC patients are unknown.

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High-Sensitivity Cardiac Troponin I Can Identify Low Risk Chest Pain Patients

MedicalResearch.com Interview with:

Dr Andrew R. Chapman BHF Clinical Research Fellow University of Edinburgh Chancellors Building Edinburgh 

Dr. Chapman

Dr Andrew R. Chapman
BHF Clinical Research Fellow
University of Edinburgh
Chancellors Building
Edinburgh 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: High-sensitivity cardiac troponin tests allow accurate measurement of cardiac troponin in the bloodstream. Currently, guidelines recommend we evaluate patients with suspected myocardial infarction using these tests, by looking for levels which are above the upper reference limit (99th centile). These troponin measurements are taken on arrival, and often repeated after admission to hospital up to six hours later. When levels are below this limit, the diagnosis of myocardial infarction is ruled out. However, using such a high limit in patients on arrival to hospital may not be safe, as lower risk stratification thresholds has been shown to reduce missed events,  and in these patients admission to hospital for repeat testing may not be necessary. However, there is no consensus as to the optimal threshold for use in practice.

In a worldwide study of 23,000 patients from 9 countries, we have shown when high-sensitivity cardiac troponin I concentrations are below a risk stratification threshold of 5 ng/L at presentation, patients are at extremely low risk of myocardial infarction or cardiac death at 30 days, with fewer than 1 in 200 patients missed. Importantly, this threshold identifies almost 50% of all patients as low risk after a single blood test. As admission or observation of these patients is estimated to cost as much as $11 billion per year in the United States, this strategy has major potential to improve the efficiency of our practice.

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Modest Increased Risk For Neonatal Side Effects After Prescribed ADHD Meds During Pregnancy

MedicalResearch.com Interview with:
“1. pregnancy” by TipsTimesAdmin is licensed under CC BY 2.0
Ulrika Nörby MScPharm, PhD
Department of E-health and strategic IT
Stockholm County Council
Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: The use of ADHD medication has increased rapidly during the last 10 years, especially among young women. Thereby, questions regarding treatment with these drugs during pregnancy are common. Until now, data concerning fetal safety of ADHD medication have been sparse, especially when it comes to neonatal disorders. For amphetamine preparations, most previous studies concerned illicit drug use during pregnancy, which made it difficult to draw conclusions. Our objective was to estimate birth and neonatal outcomes after maternal use of prescribed ADHD medication during pregnancy.

The main findings were that infants exposed to ADHD medication in utero had a somewhat increased risk of neonatal morbidity, especially CNS-related disorders. The odds ratio (OR) for a CNS-disorder was 1.9 for exposed infants compared to non-exposed infants. Further, exposed infants more often needed treatment at a neonatal intensive care unit (NICU), OR 1.5, and were more frequently moderately preterm, OR 1.3. The risk for CNS-related disorders and admission to a NICU was increased also compared to infants whose mothers used ADHD before or after, but not during, pregnancy. This finding suggests a causal relationship between treatment with ADHD medication and the neonatal outcomes. Because of large differences in maternal background characteristics between treated and non-treated women, it is however uncertain to what extent the higher neonatal morbidity is caused by the ADHD medication.

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Current Statin Guidelines May Miss Young Adults At Risk of Heart Attack

MedicalResearch.com Interview with:

Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA

Dr. Singh

Avinainder Singh, M.B.B.S.
Research Fellow
Cardiovascular Medicine
Brigham & Women’s Hospital
Harvard Medical School
Boston, MA 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Overall, the incidence of myocardial infarction (MI) in the US has declined. However, it has remained stable in adults <50 years of age.

We evaluated the statin eligibility of a cohort of adults who had an MI at a young age using current guidelines – the 2013 ACC/AHA guidelines for cholesterol treatment and the 2016 USPSTF guidelines on use of statins for primary prevention.

In, our study we found that only 49% of these young adults would have been eligible for statin therapy prior to their MI according the 2013 ACC/AHA guidelines, and only 29% would have been eligible according to the USPSTF guidelines, despite a high prevalence of cardiovascular risk factors. These numbers were even more striking for women where only 18% were eligible for statin therapy according to the USPSTF guidelines.

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Thunderclap Headache: Ottawa Rule To Exclude Subarachnoid Bleeding

MedicalResearch.com Interview with:

Jeff Perry, MD, MSc, CCFP-EM Professor, Department of Emergency Medicine Senior Scientist, Ottawa Hospital Research Institute Research Chair in Emergency Neurological Research, University of Ottawa Emergency Physician and Epidemiology Program The Ottawa Hospital Ottawa, Ontario

Dr. Perry

Jeff Perry, MD, MSc, CCFP-EM
Professor, Department of Emergency Medicine
Senior Scientist, Ottawa Hospital Research Institute
Research Chair in Emergency Neurological Research, University of Ottawa
Emergency Physician and Epidemiology Program
The Ottawa Hospital
Ottawa, Ontario

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Headache accounts for about 1-2% of all emergency department visits.  One of the most feared diagnosis within these patients is subarachnoid hemorrhage. While investigations are clearly warranted for patients with a diminished level of consciousness or new focal neurological deficits, approximately 50% of patients with subarachnoid hemorrhage (SAH) have no focal or global neurological findings. Deciding whether to image headache patients with no deficits is difficult, especially since timely diagnosis and treatment results in substantially better outcomes.

The desire to never miss a subarachnoid hemorrhage, however, contributes to escalating neuroimaging rates and a dogmatic adherence to lumbar puncture, even if the scan is negative, despite the very high sensitivity of computed tomography. However, a recent population-based study suggested that over 5% of confirmed subarachnoid hemorrhages were missed at initial presentation, especially in smaller hospitals. Therefore, identifying which headache patients require investigations to rule-out SAH is of great importance.

We have previously derived (N=1,999) and refined (N=2,131) the Ottawa SAH Rule. In this study, we conducted an multicenter prospective cohort study at six tertiary care hospitals, and found that the Ottawa SAH Rule performed well, with an 100% sensitivity, and specificity of 13.6%.

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TESLA Car May Not Trip Your Defibrillator

MedicalResearch.com Interview with:

Abdul Wase MD FACC FACP FHRS Clinical Professor of Medicine & Director, Cardiology Fellowship Program, Wright State University Boonshoft School of Medicine, Director, Electrophysiology Laboratories Good Samaritan Hospital, Dayton, OH 

Dr. Wase

Abdul Wase MD FACC FACP FHRS
Clinical Professor of Medicine &
Director, Cardiology Fellowship Program,
Wright State University Boonshoft School of Medicine,
Director, Electrophysiology Laboratories
Good Samaritan Hospital,
Dayton, OH

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Implantable cardiac defibrillators (ICD) patients are subject to electromagnetic interferences (EMI) from outside electrical sources.

TESLA electric vehicle has a large battery underneath the surface of vehicles, which may potentially interfere with the functioning of these devices. In the owner’s manual, TESLA warns that using mobile connector may impair the functioning of implantable pacemaker or a defibrillator.

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No Link Found Inhaled Steroids and Bone Fractures in Asthmatic Children

MedicalResearch.com Interview with:
“Asthma” by Michael Havens is licensed under CC BY 2.0Teresa To, PhD
Biostatistics, Design and Analysis
Scientific Director
The Hospital for Sick Children
Dalla Lana School of Public Health, University of Toronto
Institute for Clinical Evaluative Sciences
Toronto, Ontario, Canada

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We studied asthma prescription drug use in Ontario children aged 2 to 18 years with physician diagnosed asthma between 2003 and 2014.

We found that:

  1. Currently in Ontario, nearly 50% of children with asthma did not fill a prescription for an inhaled corticosteroid during the study period, despite these medications being considered the gold-standard for asthma management.
  2. Our findings did not show clinically important association between inhaled corticosteroids and fracture among children with asthma.
  3. However, systemic corticosteroids (oral or injection) are associated with higher fracture risk in children with asthma (17% higher risk).

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Eating a Mostly Plant Based Diet Linked To Lower Risk of Heart Failure

MedicalResearch.com Interview with:
“Fresh Food” by Sonny Side Up! is licensed under CC BY 2.0

 

Dr. Kyla M Lara
Icahn School of Medicine at Mount Sinai

 

 

 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This was the first study to evaluate whether dietary patterns of black and white adults living in the United States were associated with developing heart failure. We’re hearing a lot in the news about specific diets like low-fat, high protein, low carb, and other diets that decrease cardiovascular risk. We would love it, as physicians, if we could prescribe a specific diet to limit cardiovascular risk in our patients. I’m really excited about our study because instead of examining patterns of what we already know are healthy, we looked at foods people were regularly consuming in the United States and developed dietary patterns from this. This study is similar to other work we have done with stroke and heart attack.

We used data from the NIH funded REGARDS study, also known as the Reasons for Geographic and Racial Differences in Stroke. More than 30,000 white and African-American adults were recruited from 2003-2007. From this group, we studied over 18,000 adults who successfully completed a dietary assessment called the Food Frequency Questionnaire. This was a really great group to study because people who live in this particular geographic area of the Southeastern United States, also known as the stroke belt, suffer from a higher risk of death from stroke. It’s extremely important for us to better understand the major risk factors that contribute to this and also cardiovascular disease.

We used statistical techniques to derive 5 dietary patterns based on the types of foods participants tended to eat.
• Convenience – Mexican and Chinese food, mixed dishes (both meat and bean)
• Sweets – added fats, bread, chocolate, desserts, sweet breakfast foods
• Southern – added fats, fried food, organ and processed meat, fatty milk
• Alcohol/Salads – beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee
• Plant Based- fruit, vegetables, fruit juice, cereal, fish, poultry

Each participant received a score for each pattern that reflected how closely their diet resembled that dietary pattern. This approach reflects the real world and how people eat.

Over the 3135 days (8.6 years) of median follow up, 594 participants were hospitalized for incident HF. Greatest adherence to the plant-based dietary pattern during the study period was associated with a 28% risk reduction of developing heart failure.
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