Author Interviews, Heart Disease, NEJM, Surgical Research / 16.08.2017

MedicalResearch.com Interview with: A. Laurie Shroyer, Ph.D., M.S.H.A. WOC Health Science Officer Northport VAMC Research and Development Office (151) Northport, NY 11768 Professor and Vice Chair for Research, Department of Surgery Stony Brook University, School of Medicine Stony Brook, NY  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Since the 1990’s, two different approaches have been commonly used by cardiac surgeons to perform an adult coronary artery bypass graft (CABG) procedure, these approaches have been referred to as  “on-pump” (with cardiopulmonary bypass) or “off-pump” (without cardiopulmonary bypass) procedures. The Department of Veterans Affairs (VA) Randomized On/Off Bypass Follow-up Study” (ROOBY-FS) compared the relative performance of off-pump versus on-pump approaches upon 5-year patients’ clinical outcomes including mortality and major adverse cardiovascular events. (more…)
Author Interviews, BMJ, Pain Research, Rheumatology / 16.08.2017

MedicalResearch.com Interview with: Jos Runhaar, PhD Erasmus MC Department of General Practice Rotterdam The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Response: Most international guidelines report an overall lack of efficacy of glucosamine for osteoarthrits. We however know that it is a very heterogeneous disease. Therefore, it is possible that there are certain subgroups of osteoarthritis patients that actually might have effect from glucosamine; for instance subgroups based on different pathologies underlying the clinical presentation, different co-morbidities, or different disease stages. For investigating efficacy in subgroups large sample sizes are needed, and certain methodological techniques are necessary, to get a valid and robust answer. Several years ago, a group of renowned international osteoarthritis researchers started the OA Trial Bank especially for investigating these subgroup effects of osteoarthritis treatments and collect individual patient data of worldwide-performed intervention studies in osteoarthritis patients. When using the individual patient data of multiple studies, it brings us the large sample size and allows us to use the right methods. We do these subgroup analyses in the OA Trial Bank for many different interventions, not just for glucosamine. The subgroup analyses for glucosamine and for corticosteroid injections are published, the others are ongoing (for instance exercise, orthoses and topicals) or planned and still waiting for funding. The study did show, however, that glucosamine can be extremely beneficial for pets, and specifically dogs who have joint related issues. Knowing the most valuable sources of glucosamine for dogs is important, as it can be extracted and gained from multiple sources, and each have their own varied levels of quality and potency. (more…)
Author Interviews, Cost of Health Care, Dermatology, JAMA / 16.08.2017

MedicalResearch.com Interview with: Kyle T. Amber, MD Department of Dermatology UC Irvine Health Irvine, CA 92697-2400  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The use of IVIg has been shown in randomized controlled trials to be safe and highly effective in the treatment of both pemphigus and bullous pemphigoid. Despite its efficacy, its cost remains a deterrent to its use. Cost studies in the United States point towards IVIg being an overall cost-saving therapy in the treatment of  Autoimmune Blistering Diseases when compared to traditional immunosuppressive treatment due to the decrease in associated infections, complications, and hospitalizations. (more…)
Author Interviews, Diabetes, Education, JAMA, Pediatrics / 16.08.2017

MedicalResearch.com Interview with: Jane E. Harding, DPhil Liggins Institute The University of Auckland Auckland, New Zealand MedicalResearch.com: What is the background for this study? Response: Neonatal hypoglycaemia – low blood sugars in newborns – affects up to one in six babies born. It involves a sustained dip in blood sugar levels following birth. Blood glucose is the only fuel for babies’ brains (adults have alternative, back-up sources). So, if left untreated, this condition can cause developmental brain damage and lowered education outcomes later in life. In developed economies, as many as a third of babies born are at risk. Risk factors include being born smaller or larger than usual, preterm babies and babies whose mothers have any form of diabetes – this last a growing group, with the rising incidence of gestational (pregnancy-related) diabetes. We wanted to systematically track a cohort of babies to see if hypoglycaemia in babies affects their long-term health and development. So we designed the CHYLD study – Children with Hypoglycaemia and their Later Development. We are following 614 New Zealand babies born at risk of low blood sugar levels (neonatal hypoglycemia) into childhood to see if the condition affects their later growth and development. Our team includes researchers from the Liggins Institute, the University of Auckland, Waikato Hospital, the University of Canterbury and the University of Waterloo. Half of the babies in the study were diagnosed with, and treated for low blood sugars. Seventy percent received extra, continuous monitoring of their blood sugar levels, which detected in some babies low levels that were not diagnosed by the heel-prick tests. (more…)
Author Interviews, JAMA, Ophthalmology, Pediatrics / 16.08.2017

MedicalResearch.com Interview with: Mary Elizabeth Hartnett, MD, FACS, FARVO Professor of Ophthalmology, Vitreoretinal Service and Surgery Principal Investigator Retinal Angiogenesis Laboratory Director of Pediatric Retina, Adjunct Professor of Pediatrics John A. Moran Eye Center Salt Lake City UT 84132 On behalf of the co-authors: Julia Shulman, Cindy Weng, Jacob Wilkes, Tom Greene, M. Elizabeth Hartnett MedicalResearch.com: What is the background for this study? Response: Maternal preeclampsia causes morbidity to mothers and infants worldwide. Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. This study was done to gain insight into the effects of preeclampsia on ROP in a clinical population. The literature is mixed with some reports that preeclampsia increases risk of Retinopathy of prematurity, whereas others suggest preeclampsia is protective or has no effect. The presence of circulating anti-angiogenic factors in preeclamptic mothers that can enter the fetal circulation lends biologic plausibility to the notion that maternal preeclampsia might interfere with developing vascular beds in the fetus, such as the retina, and potentially lead to severe ROP. However, a report using an experimental model provided evidence that uteroplacental insufficiency, a characteristic of preeclampsia, led to protective mechanisms in the offspring that reduced oxygen-induced retinopathy and promoted overall growth. (more…)
Author Interviews, Cancer Research, CDC / 15.08.2017

MedicalResearch.com Interview with: Mary C. White, ScD MPH Epidemiology and Applied Research Branch Division of Cancer Prevention and Control CDC Atlanta GA 30341 MedicalResearch.com: What is the background for this study? Response: Most cancers are caused not by just one thing, but instead by a combination of different factors over many years. Early adulthood is a time of many life changes and stresses, and exposure to harmful products and unhealthy habits during early adulthood can set the stage for developing cancer at older ages. We analyzed responses from a national sample of young adults to questions about diet, physical activity, tobacco products, alcohol, indoor tanning, sleep, the HPV vaccine, and obesity. These factors have been linked to higher risks of different types of cancer. (more…)
Author Interviews, Exercise - Fitness, Geriatrics, JAMA / 15.08.2017

MedicalResearch.com Interview with: Jennifer Brach, Ph.D., P.T. Associate professor, Department of physical therapy School of Health and Rehabilitation Sciences University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study compared two different group exercise programs to improve mobility in community-dwelling older adults. The first program, a seated program focused on strength, endurance and flexibility, was based on usual care. The second program, called On the Move, was conducted primarily in standing position and focused on the timing and coordination of movements important for walking. Both programs met two times per week for 12 weeks. It was found that the On the Move program was more effective at improving mobility than the usual seated program. (more…)
Author Interviews, Psychological Science, Social Issues / 15.08.2017

MedicalResearch.com Interview with: Allison Mueller, A.B.D. Ph.D. Program Department of Psychology University of Illinois at Chicago  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In our study, we explored how people react to public figures who bend the truth. We predicted that people’s own moral conviction for a political issue—their strong and absolute belief that this position is right or wrong, moral or immoral—would cloud their judgments of public figures who lie for that cause. We reasoned that when a strong moral conviction is at stake, the transgressiveness of specific kinds of advocacy for the cause may be trivialized. To test this idea, we first assessed people’s views on a political issue—in this case, whether they supported or opposed federal funding of Planned Parenthood, and the extent to which they viewed the issue as a moral imperative. They were then presented with a political monologue supporting Planned Parenthood that they believed was previously aired over public radio. After reading the monologue, they were randomly assigned to learn that the monologue was deemed true (or false) by several fact-checking organizations. We measured their reactions to hearing this news, including the extent to which they believed the speaker was justified in delivering the monologue and their judgments of the speaker’s moral character. We found that people’s perceptions of the speaker’s transgressive advocacy were uniquely shaped by their own moral conviction for the cause. Although honesty was positively valued by all respondents, transgressive advocacy that served a shared moral (vs. nonmoral) end was more accepted, and advocacy in the service of a nonpreferred end was more condemned, regardless of its truth value.  (more…)
Author Interviews, Geriatrics, Psychological Science / 15.08.2017

MedicalResearch.com Interview with: Johanna MH Nijsten, Msc Clinical Neuropsychologist Archipel Landrijt, Knowledge Center for Specialized Care Eindhoven, the Netherlands Department of Primary and Community Care, Radboudumc Alzheimer Center Radboud University Medical Center Nijmegen, the Netherlands  MedicalResearch.com: What is the background for this study? Response: Apathy is common in nursing home (NH) patients with dementia and is repeatedly found to be the most prevalent neuropsychiatric symptom. Apathy is defined by diminished or lack of motivational, goal-directed behavior, and a lack of cognition and emotional affect. Apathy leads to reduced interest and participation in the main activities of daily living, diminished initiative, early withdrawal from initiated activities, indifference, and flattening of affect. Over the last two decades, more scientific knowledge has become available about specific fronto-subcortical systems in the brain that may be highly involved in apathy. Disruptions in these systems are found in patients with frontal lobe damage resulting from, for instance, (early-onset) dementia, traumatic brain injury, stroke, or multiple sclerosis. Fronto-subcortical circuits also play an important role in neurological disorders involving the basal ganglia such as Parkinson’s disease and Huntington’s disease. The neurodegenerative diseases and acquired brain injuries mentioned here are highly prevalent in patients receiving long-term NH care and the widespread clinical manifestation of apathy in NH-patients is thought to be related. Since apathy is very common in nursing home-patients and may lead to a poor prognosis, clear insight into its risk for mortality is needed and NH-staff need to understand this risk. (more…)
Author Interviews, Gastrointestinal Disease, JAMA / 15.08.2017

MedicalResearch.com Interview with: Maureen Leonard, MD MMSc Clinical Director, Center for Celiac Research and Treatment Instructor in Pediatrics Associate Investigator, Nutrition Obesity Research Center Harvard Medical School Pediatric Gastroenterology & Nutrition MassGeneral Hospital for Children   MedicalResearch.com: What is the background for this study? What are the main findings? Response: In this systematic review, we discuss the clinical approach to celiac disease and nonceliac gluten sensitivity, highlighting how to distinguish between these two conditions and their management. These disorders cannot be distinguished based on symptoms. A single elevated serology test is not diagnostic for celiac disease, and patients with abnormal serologic testing must be referred to a gastroenterologist for further testing and remain on a gluten-containing diet until their diagnostic evaluation is completed. While the treatment for both conditions is a gluten-free diet, the possibility of long-term complications differs. (more…)
Author Interviews, Cancer Research, CMAJ, HPV, Vaccine Studies / 14.08.2017

MedicalResearch.com Interview with: Steven Habbous MSc, PhD candidate Ontario Cancer Institute Scarborough, Ontario, Canada MedicalResearch.com: What is the background for this study? Response: Human papillomavirus (HPV) is a strong risk factor for oropharyngeal cancers (a subset of head and neck cancers). Because HPV-related oropharyngeal cancers generally respond well to treatment and may be prevented through HPV vaccination, it is critical to be able to accurately estimate the incidence and prevalence of this disease. Only recently, however, has testing for HPV become routine at most cancer centres across Canada.  As a result, attempts to estimate the growth of HPV-related oropharyngeal cancer over time may be inaccurate. (more…)
Author Interviews, Cancer Research, Cost of Health Care, Duke, JAMA / 11.08.2017

MedicalResearch.com Interview with: Dr. Fumiko Chino, MD Duke Radiation Oncology Duke School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: The financial burden of cancer treatment is a growing concern. Out-of-pocket expenses are higher for patients with cancer than for those who have other chronic illnesses. Fifty percent of elderly cancer patients spend at least 10% of their income on treatment-related out-of-pocket expenses. Additionally, high financial burden is associated with both increased risk of poor psychological well-being and worse health-related quality of life. A cancer diagnosis has been shown to be an independent risk factor for declaring personal bankruptcy, and cancer patients who declare personal bankruptcy are at greater risk for mortality. These potentially harmful outcomes resulting from financial burden have been recognized as the financial toxicity of cancer therapy, analogous to the more commonly considered physical toxicity. We conducted an IRB approved study of financial distress and cost expectations among patients with cancer presenting for anti-cancer therapy. In this cross-sectional, survey based study of 300 patients, over one third of patients reported higher than expected financial burden. Cancer patients with highest financial distress are underinsured, paying nearly 1/3 of income in cancer-related costs. In adjusted analysis, experiencing higher than expected financial burden was associated with high/overwhelming financial distress (OR 4.78; 95% CI 2.02-11.32; p<0.01) and with decreased willingness to pay for cancer care (OR 0.48, 95% CI 0.25-0.95, p=0.03). Sambla, a Scandinavian lender, has been working with many patients to prevent any financial distress resulting from unexpected medical bills. As a result of customer feedback, it has modified the terms of all loans it issues to allow for jumbo loan sizes and reduced interest rates, combined with longer repayment times to help its borrowers. (more…)
Author Interviews, Cancer Research, OBGYNE, PLoS / 11.08.2017

MedicalResearch.com Interview with: Jane McElroy, Ph.D. Associate professor Department of Family and Community Medicine MU School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than 31,000 new cases of endometrial cancer are expected to be diagnosed in 2017. Through a five-year observational study, we found that women with increased levels of cadmium had an increased risk of endometrial cancer. Cadmium is a metal commonly found in foods such as kidneys, liver and shellfish as well as tobacco It’s a finding we hope could lead to new treatments or interventions to prevent the fourth most common cancer in women. (more…)
Accidents & Violence, Alzheimer's - Dementia, Author Interviews, Depression, Geriatrics, Karolinski Institute / 11.08.2017

MedicalResearch.com Interview with: Heidi Taipale, PhD Pharm Senior Researcher School of Pharmacy, University of Eastern Finland; and Department of Clinical Neuroscience Karolinska Institutet  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Antidepressant use among older persons has been associated with an increased risk of falling and fall-related events, such as hip fractures, in previous studies. Our previous study identified risk of hip fractures in antidepressant among persons with Alzheimer’s disease. As falling is the main causal factor for head traumas and traumatic brain injuries among older persons, we hypothesized that antidepressant use could also be associated with these injuries. We utilized a nationwide cohort of 70,718 persons newly diagnosed with Alzheimer’s disease, identified from the Finnish registers. The risk of head injuries and traumatic brain injuries was compared between persons initiating antidepressant use and comparison persons of the same age, gender and time since they received diagnoses of Alzheimer’s disease but not using antidepressants. We found a 40-percent increased risk of head injuries and 30-percent increased risk of traumatic brain injuries associated with antidepressant use. Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use – during the first 30 days – but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors. (more…)
Author Interviews, Occupational Health, Social Issues / 10.08.2017

MedicalResearch.com Interview with: Professor Tarani Chandola Cathie Marsh Institute and Social Statistics www.cmist.manchester.ac.uk University of Manchester Co-director of the National Centre for Research Methods International Centre for Lifecourse Studies in Society & Health MedicalResearch.com: What is the background for this study? Response: The study examined the common perception that “any job is better than no job” to see whether this was true in terms of chronic stress levels. It followed up a group of unemployed adults representative of adults living in the UK, and compared their health and stress levels in terms of those who remained unemployed and those who became re-employed in poor and good quality work. (more…)
Annals Internal Medicine, Author Interviews, Hepatitis - Liver Disease / 10.08.2017

MedicalResearch.com Interview with: Sarah Kattakuzhy, MD Clinical and Administrative Director, DC PFAP Hepatitis Clinical Research Program Assistant Professor, Institute of Human Virology Division of Infectious Diseases University of Maryland  Sarah Kattakuzhy, MD Clinical and Administrative Director, DC PFAP Hepatitis Clinical Research Program Assistant Professor, Institute of Human Virology Division of Infectious Diseases University of Maryland   MedicalResearch.com: What is the background for this study? What are the main findings? Response: The recent introduction of highly effective, well-tolerated direct-acting antiviral (DAA) therapy for hepatitis C virus infection has raised the possibility of rapid treatment expansion and widespread cure. However, the current specialist workforce is insufficient to meet the treatment demands of the 2.7 million Americans living with HCV infection. Several studies of partial task shifting—shared treatment between specialists and primary care providers—have demonstrated success in improving access to HCV care. Yet, information on the success of nonspecialists practicing independent of specialist supervision is limited. The primary objective of ASCEND was to evaluate the efficacy of Hepatitis C treatment managed independently by 3 community-based provider types—nurse practitioners (NPs), PCPs, and specialists—after a succinct, guideline-driven educational intervention, set within a real-world, urban population. In this investigation, 516 out of 600 patients achieved SVR, a response rate of 86% (95% CI, 83.0% to 88.7%), with no major safety signals. Rates of SVR were consistent across the 3 provider types—NPs: 89.3% (CI, 83.3% to 93.8%); PCPs: 86.9% (CI, 80.6% to 91.7%); and specialists: 83.8% (CI, 79.0% to 87.8%). Patient loss to follow-up was the major cause of non-SVR. (more…)
AHA Journals, Author Interviews, Heart Disease, Pediatrics, Social Issues / 10.08.2017

MedicalResearch.com Interview with: Lead author, Dr Richard Liu, MCRI Ph.D. student and Senior author - Professor David Burgner PhD The Child Health CheckPoint Investigator Group Murdoch Children’s Research Institute The Royal Children’s Hospital Parkville, Victoria, Australia MedicalResearch.com: What is the background for this study? What are the main findings? Response: The socioeconomic gradient in cardiovascular disease is well recognised in adults. The more disadvantaged someone is, the higher their risk of heart attack and stroke. The mechanisms by which this occurs are not well understood, but we know the pathological process underlying this, thickening of the arteries, or atherosclerosis, begins very early in life. Our current understanding of the early development of atherosclerosis has previously been limited mainly to autopsy studies. Non-invasive imaging is increasingly being used to examine the early development of atherosclerosis. We wanted to determine if there was an association between socioeconomic disadvantage and the thickness of the carotid artery wall in mid-childhood, which in adults is a proxy for atherosclerosis and indicates higher risk for heart attack and stroke in later life. We analysed both family and neighbourhood socioeconomic position data from 1477 Australian families, which included data on income, education and occupation of parents, as well as the relative socioeconomic status of the immediate neighbourhood. (more…)
Author Interviews, Sleep Disorders / 10.08.2017

MedicalResearch.com Interview with: Roland Staud, M.D. Professor of Medicine University of Florida Gainesville, FL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Fatigue after exertion or sleep loss is normal. However, fatigue at rest is not. Resting fatigue is reported by cancer, heart disease, RA, SLE patients and patients with chronic fatigue syndrome (CFS). CFS has been mostly associated with chronic infections but findings are inconsistent. We hypothesized that chronic fatigue is signaled by sensitized tissue receptors to the CNS where minute amounts of muscle metabolites can activate these receptors (metabo-receptors). Why the receptors are sensitized is unclear. To test our hypothesis we injected CFS patients with lidocaine or normal saline into muscles once. We saw a statistical improvement of overall fatigue (27%) with lidocaine compared to saline. Conclusion: Chronic fatigue syndrome patients are using metabo-receptors for inappropriately signaling fatigue to the CNS. (more…)
Author Interviews, Flu - Influenza, Kaiser Permanente, Merck, NEJM, Vaccine Studies / 10.08.2017

MedicalResearch.com Interview with: Michael Jackson  PhD, MPH Kaiser Permanente Washington Health Research Institute (KPWHRI) principal investigator for the United States Influenza Vaccine Effectiveness Network  MedicalResearch.com: What is the background for this study?
  • Response: Each year, Kaiser Permanente Washington is one of five sites across the country that participate in the United States Influenza Vaccine Effectiveness Network. The Network reports its early interim results in the MMWRand presents additional interim results to the Advisory Committee on Immunization Practices (ACIP). This New England Journal of Medicine publication is an update of those interim results.
  • The findings in this New England Journal of Medicine are special because prior randomized controlled trials indicated that the nasal spray vaccine (FluMist)—also called live attenuated influenza vaccine (LAIV)—would work well to protect children and teens from the flu, whereas in actual practice we found that the flu shot worked much better, particularly against the predominant strain, A(H1N1)pdm09.
  • The nasal spray vaccine was first seen to be less effective for young children than the flu shot in 2013-2014 for the A(H1N1)pdm09 virus strain. In response, the A(H1N1)pdm09 virus strain used in the nasal spray vaccine was changed for the 2015-2016 influenza season. The 2016/17 season was the first since 2015-2016 to be dominated by the A(H1N1)pdm09 virus, making this our first opportunity to evaluate the updated nasal spray vaccine.
  • The Influenza Vaccine Effectiveness Network evaluated the impact of this change as part of our estimates of influenza vaccine effectiveness in 2015-2016. Preliminary findings from this study were presented to the ACIP in June 2016, which led to the nasal spray vaccine not being recommended in 2016-2017 in the US, although the nasal spray vaccine remains licensed in the US. In 2016-2017, the LAIV A(H1N1)pdm09 vaccine strain was unchanged from 2015-2016.
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Author Interviews, Pediatrics / 10.08.2017

MedicalResearch.com Interview with: Layla Parast PhD Statistician RAND MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study examined the association between pet ownership, specifically dog or cat ownership, and children’s physical and mental health. There has been a lot of previous work looking at this association and these previous results seemed to show that kids with pets have better health than those without pets. The hypothesis has been that pets can improve children’s health by increasing physical activating and improving young people’s empathy skills. We used data from over 5,000 households in California which was obtained from the California Health Interview Survey and looked at physical and mental health outcomes among children in households with pets vs. without pets. We found that children in households with pets do have better health than those without pets, but that after we account for factors such as family income and housing type, for example, there is no evidence of an association between pet ownership and health. That is, households that have pets are more likely to be higher income, to be in a house as opposed to an apartment, and to have healthier adults in the household, for example - and these factors are also associated with better child health. (more…)
Author Interviews, Psychological Science, Social Issues / 09.08.2017

MedicalResearch.com Interview with: Mirkka Danielsbacka PhD, D.Soc.Sci Senior researcher University of Turku MedicalResearch.com: What is the background for this study? What are the main findings? Response: Relations between family generations are widely studied in disciplines such as family sociology and demography. However, relations between in-laws are often neglected in family studies of contemporary societies. Especially conflicts have been surprisingly little investigated. We were especially interested in how parenthood is associated with relations to in-laws in a contemporary Western society. Using nationally representative survey data from Finland with over 1,200 respondents, we studied conflicts that spouses reported having with their own parents and their in-laws. Overall, Finns more often reported having had any conflict with their own parents than with their in-laws. Compared to childless couples, couples with children were as likely to report conflicts with their own parents. However, couples with children were more likely to report conflicts with their parents-in-law. Our results took into account how frequently family members were in contact with each other and how emotionally close they felt, as well as other sociodemographic factors. (more…)
Author Interviews, Cancer, Cancer Research, Opiods / 09.08.2017

MedicalResearch.com Interview with: Rinku Sutradhar, Ph.D. Senior Scientist, Institute for Clinical Evaluative Sciences Associate Professor, Dalla Lana School of Public Health University of Toronto, Canada MedicalResearch.com: What is the background for this study? What are the main findings?
  • We suspected that pain was prevalent among survivors of cancer, but there were no comprehensive estimates on the magnitude of this prevalence. For example, recent work had reported pain prevalence among cancer survivors to be anywhere from 5% to 56%, which is quite a wide range.
  • To our knowledge, there has been no prior research conducted at the individual-level that specifically examines opioid prescribing rates for cancer survivors, compared to matched control groups who have no prior cancer diagnosis.
  • We also know that socio-economically disadvantaged populations are more at risk for opioid dependency, but previous studies have not examined cancer survivors who a part of this disadvantaged group, so this is an important knowledge gap to fill.
  • We found that cancer survivors have significantly higher rates of opioid prescriptions compared with their matched controls (who had no prior cancer diagnosis). In fact, after adjusting for other study factors, we found that the rate of opioid prescriptions was 22% higher among survivors.
  • MOST SURPRISING: This higher rate of opioid prescriptions persisted even among survivors who were 10 or more years past their cancer diagnosis (compared to matched control individuals who had no prior cancer diagnosis).
  • When we broke the cohort down based on the type of cancer, we didn’t see a significant spike in opioid prescriptions for breast cancer survivors compared to their non-cancer controls, but we did see higher opioid prescriptions for survivors of lung, gastrointestinal, genitourinary, or gynaecological cancers, compared to their controls.
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Annals Internal Medicine, Author Interviews, CDC, HIV / 09.08.2017

MedicalResearch.com Interview with: Dr. Nicole Crepaz PhD Behavioral Scientist Division of HIV/AIDS Prevention CDC MedicalResearch.com: What is the background for this study? Response: The most common measure of viral suppression in clinical and surveillance studies is the most recent viral load in past 12 months. This single-value measure does not capture the viral load dynamics over time. We examined durable viral suppression, never virally suppressed, and cumulative HIV burden (measured in the viremia copy-year) to help us better understand viral suppression and transmission risk potential. (more…)
Author Interviews, Heart Disease, JAMA, Outcomes & Safety, Race/Ethnic Diversity / 09.08.2017

MedicalResearch.com Interview with: Dr. Lee Joseph, MD, MS Postdoctoral fellow at University of Iowa Division of Cardiovascular Diseases Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City MedicalResearch.com: What is the background for this study? Response: In-hospital cardiac arrest (IHCA) is common and affects more than 200,000 patients every year. Although survival for in-hospital cardiac arrest has improved in recent years, marked racial differences in survival are present. A previous study showed that black patients with in-hospital cardiac arrest have 27% lower chance of surviving an in-hospital cardiac arrest due to a shockable rhythm compared to white patients. Moreover, lower survival in black patients was largely attributable to the fact that black patients were predominantly treated in lower quality hospitals compared to white patients.  In other words, racial disparities in survival are closely intertwined with hospital quality, and this has been borne out in multiple other studies as well In this study, we were interested in determining whether improvement in in-hospital cardiac arrest survival that has occurred in recent years benefited black and white patients equally or not? In other words, have racial differences in survival decreased as overall survival has improved. If so, what is the mechanism of that improvement? And finally, did hospitals that predominantly treat black patients make the greatest improvement in survival? To address these questions, we used data from the Get With The Guidelines-Resuscitation, a large national quality improvement registry of in-hospital cardiac arrest that was established by the American Heart Association in the year 2000. Participating hospitals submit rich clinical data on patients who experience in-hospital cardiac arrest. Over the last 17 years, the registry has grown markedly and currently includes information on >200,000 patients from > 500 hospitals. The primary purpose is quality improvement. But it has also become an important resource to conduct research into the epidemiology and outcomes associated with in-hospital cardiac arrest. Using data from the Get With the Guidelines-Resuscitation, we identified 112,139 patients at 289 hospitals between 2000-2014. Approximately 25% of the patients were of black race and the remainder were white patients. We constructed two-level hierarchical regression models to estimate yearly risk adjusted survival rates in black and white patients and examined how survival differences changed over time both on an absolute and a relative scale. (more…)
Author Interviews, FASEB / 08.08.2017

Substances in Spit May Help Wounds Heal Faster

MedicalResearch.com Interview with: Vicente A. Torres PhD Associate Professor Institute for Research in Dental Sciences Faculty of Dentistry Universidad de Chile  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Wounds in the oral cavity heal faster and more efficiently than skin. This is in part due to saliva. However, the reasons underlying these differences remain poorly known. Since blood vessel formation (i.e. angiogenesis) is critical to the success and efficiency of wound healing, we focused our studies on the effects of saliva, and specifically the salivary molecule, histatin-1, on angiogenesis. Our studies showed that histatin-1 promotes angiogenesis, as observed in experiments performed at three "levels": 1) using human cell cultures (endothelial cells, which are cells that form blood vessels), (2) using chicken embryos, as animal models, and (3) analyzing saliva samples obtained from healthy donors. With all these models, histatin-1 and saliva were found to increase blood vessel formation. In addition, our studies provide information about the molecular mechanisms (i.e. signaling pathways) whereby endothelial cells respond towards histatin-1, by increasing their migration and adhesion to the extracellular matrix. (more…)
Author Interviews, Diabetes, Lancet, Parkinson's / 08.08.2017

MedicalResearch.com Interview with: Dr Dilan Athauda MRCP Sobell Department of Motor Neuroscience and Movement Disorders UCL Institute of Neurology & The National Hospital for Neurology and Neurosurgery London MedicalResearch.com: What is the background for this study? Response: Exenatide is a synthetic version of a naturally occurring protein - exendin-4 - that was originally discovered by Dr John Eng in the early 1990’s in the saliva of the Gila Monster, a venomous lizard native to the Southwestern United states. He and his team were looking for bio-active peptides in insect and lizard venom that could be useful for people with Type 2 diabetes. They discovered that exendin-4 was extremely similar to a human hormone called Glucagon-like peptide-1 (GLP-1).  In humans, GLP-1 is secreted after you eat a meal to stimulate insulin secretion (and inhibit glucagon production) of which the end result is a lowering of blood sugar. Unfortunately human GLP-1 is rapidly broken down by a circulating enzyme called dipeptidyl peptidase IV (DPP-IV) and its effects only last minutes. Importantly, it was discovered that exendin-4 is naturally resistant to the actions of this enzyme, meaning it’s effects on blood sugar control lasts much longer in the body.  These properties made it very attractive to people trying to treat people with Type 2 diabetes and following many successful randomised controlled trials of patients with Type 2 diabetes in 2005, exenatide was approved for use as a treatment.  During this time, work led by Nigel Greig’s group at the NIA showed that first evidence that exendin-4 had neuroprotective properties, and could protect neurons from a variety of stresses and could also improve growth and rescue degenerating cells. Over the next few years, various groups used exendin-4 in a variety of animal toxin models of Parkinson’s disease and showed that exendin-4 could halt the progression of Parkinsonism and prevent cell death in these models through beneficial effects on inflammation, mitochondrial function and cell survival. Based on this encouraging pre-clinical data, Professor Foltynie supervised the first small, “open-label”, human trial of exenatide in patients with Parkinson’s disease.  The team found that patients treated with exenatide for 1 year (in addition to their usual medication) had less decline in their motor symptoms when assessed without their medication compared to the control group (just on their usual medication) and this advantage over the control group was still present 1 year after stopping the exenatide injections.  However, this trial was open-label – patients knew they were getting a (potentially beneficial) experimental therapy and so we couldn’t exclude the fact that placebo effects were explaining some of the results we saw. As a result of the potentially beneficial results seen in this small open label trial we carried out a double-blind, placebo controlled trial. (more…)
Author Interviews, Cancer Research, Colon Cancer, Race/Ethnic Diversity / 08.08.2017

MedicalResearch.com Interview with: Rebecca Siegel, MPH Strategic Director, Surveillance Information Services American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Colorectal cancer (CRC) incidence rates have been increasing in people under 55 since at least the mid-1990s, despite rapid declines in older age groups. We analyzed mortality data covering over 99% of the US population and found that death rates for CRC in adults under 55 have been increasing over the past decade of data (2004-2014) by 1% per year, in contrast to rapid declines in previous years. This indicates that the increase in incidence is not solely increased detection due to more colonoscopy use, but a true increase in disease occurrence that is of sufficient magnitude to outweigh improvements in survival because of better treatment for colorectal cancer. The second major finding was that the rise in death rates was confined to whites, among whom death rates rose by 1.4% per year, for an overall increase of 14%. In blacks, the colorectal cancer death rate declined slowly during the entire study period (1970-2014). This racial disparity is consistent with incidence, but in contrast to trends for major risk factors for CRC, like obesity, which has increased across all racial and ethnic groups. This means that the obesity epidemic is probably not wholly responsible for the increase in disease. Third major finding was that CRC death rates are increasing in people in their early 50s, for whom screening has been recommended for decades. This was particularly surprising since CRC screening has a two-fold impact on death rates by both preventing cancer and detecting it early when treatment is more effective. Rising death rates in this age group likely reflects lower screening rates in ages 50-54 than 55+ -- 46% vs 67% in 2015, probably because of delayed initiation of screening. (more…)
Author Interviews, Cost of Health Care, JAMA, Social Issues / 07.08.2017

MedicalResearch.com Interview with: Arlene S. Ash, PhD Department of Quantitative Health Sciences University of Massachusetts Medical School Worcester  MedicalResearch.com: What is the background for this study? What are the main findings? Response: State Medicaid programs (and other health care purchasers) often contract with several managed care organizations, each of which agrees to address all health care needs for some of their beneficiaries. Suppose a Medicaid program has $5000 to spend, on average, for each of its 1 million beneficiaries. How much should they pay health plan “A” for the particular 100,000 beneficiaries it enrolls? If some group, such as those who are homeless, is much more expensive to care for than the payment, plans that try to provide good care for many such people will go broke. We describe the model now used by MassHealth to ensure that plans get more money for enrolling patients with greater medical and social needs. In this medical-social model, about 10% of total dollars is allocated by factors other than the medical-morbidity risk score. (more…)
Author Interviews, Cost of Health Care, JAMA, Lipids, University of Pittsburgh / 07.08.2017

MedicalResearch.com Interview with: Inmaculada Hernandez, PharmD, PhD Assistant Professor of Pharmacy and Therapeutics University of Pittsburgh School of Pharmacy Pittsburgh, PA 1526 MedicalResearch.com: What is the background for this study? Response: A few months ago, the results of the FOURIER trial were published. This trial was the first one to evaluate the efficacy of PCSK9 inhibitors in the prevention of cardiovascular events, since the approval of these agents was based on trials that evaluated their efficacy in reducing levels of LDL-C. The results of the FOURIER trial did not meet the expectations generated by prior studies that had simulated how much the risk of cardiovascular events should decrease based on the observed reduction in LDL-C levels. A few hours after the publication of the results of the FOURIER trial, Amgen (evolocumab´s manufacturer) announced that it would be willing to engage in contracts where the cost of evolocumab would be refunded for those patients who suffer a heart attack or a stroke while using the drug. (more…)