Author: Marie Benz MD FAAD
04 Sep Do High Phthalates Levels Increase Risk of Miscarriage?
MedicalResearch.com Interview with: Dr. Jianying Hu Laboratory for Earth Surface Processes College of Urban and Environmental Sciences Peking University, Beijing People’s Republic of China Medical Research: What is the background for this study? What are the main findings? Response: Early pregnancy loss or first-trimester miscarriage is the most common complication of human reproduction, and the miscarriage incidence is increasing around the world in the recent decades. Though there are many causes for miscarriage, approximately 40% of early pregnancy loss remains unexplained. Exposure to endocrine disrupting chemicals (EDCs) has been considering one of major risk factor to affect female reproduction. Of these EDCs related to reproductive toxicity, phthalates is of concern due to their wide usage and contamination in environment, and the reproductive toxicity in the female mouse. Our study found that the levels of phthalates in the women who underwent miscarriage were statistically significantly high, and the risk of clinical pregnancy loss was associated with urinary concentration of phthalate metabolites.03 Sep Wild Blueberry Polyphenols May Help Fight Periodontal Disease
MedicalResearch.com Interview with:
Daniel Grenier, Ph.D.
Professeur titulaire
Oral Ecology Research Group, Faculty of Dentistry, and Institute of Nutrition and Functional Foods, Université Laval
Quebec City, QC, Canada
Medical Research: What is the background for this study?
Dr. Grenier: Periodontal diseases (gingivitis and periodontitis) are major public health problems because of their high prevalence and incidence in all regions of the world. According to epidemiological studies, approximately 5% of North Americans suffer from severe generalized periodontitis, which can lead to tooth loss, while mild to moderate periodontitis affects up to 35% of adults. Given emerging data indicating that there is a relationship between periodontal diseases and systemic health problems such as diabetes, cardiovascular diseases, and preterm birth, studies on preventive and therapeutic strategies targeting periodontal diseases are highly relevant.
Medical Research: What are the main findings?
Dr. Grenier: Using various in vitro models, we brought clear evidence that a blueberry extract enriched in proanthocyanidins can act on the two etiological components of periodontal disease. We first showed that these polyphenols inhibit the growth of Fusobacterium nucleatum as well as its ability to form a biofilm, which can provide to the bacterium a resistance to antimicrobial agents and immune cells. Interestingly, F. nucleatum has been associated with various forms of periodontitis as well as to a number of extra-oral infections, including endocarditis, inflammatory bowel disease, and brain abscesses. Moreover, the blueberry extract attenuated the inflammatory response of human macrophages challenged with F. nucleatum, resulting in a decreased secretion of inflammatory cytokines (IL-1β, IL-6, TNF-α) and tissue destructive enzymes (MMP-8, MMP-9). Evidence was brought that this property is likely related to the ability of the blueberry polyphenols to block the activation of the NF-κB signaling pathway that play a key role in inflammatory reactions.
Over the last decade, my laboratory has been investigating the potential benefits of various classes of polyphenols for oral health. Polyphenols are a large group of natural substances found in plants and characterized by the presence of more than one phenol unit per molecule. Given that wild blueberries (Vaccinium angustifolium Ait), a popular berry fruit in Quebec, are particularly rich in a specific class of polyphenols, called proanthocyanidins, we tested their effect on the two major etiological factors involved in the pathogenesis of periodontitis: a limited group of Gram negative anaerobic bacteria, and an uncontrolled host immune response to these pathogens that results in the secretion of high amounts of inflammatory mediators which modulate the progression and severity of periodontitis.
03 Sep Microscopic Regression in Thin Melanoma May Be Good Prognostic Sign
MedicalResearch.com Interview with:
Simone Ribero, M.D., Ph.D.
University of Turin
Department of Medical Sciences
Turin Italy and
King’s College London
Department of Twin Research and Genetic Epidemiology
St Thomas’ campus London, UK
Medical Research: What is the background for this study? What are the main findings?
Response: The histologic regression is a discussed feature and its prognostic role is debated in literature. Our group has previously described a favorable prognostic role of histological regression in stage I-II melanoma patients. Some clinicians still perform Sentinel Lymph Node biopsy on the basis of regression in thin melanoma considering this feature as able to underestimate Breslow Thickness.
In this study we described in a metanalyses with more then 10000 melanoma patients that histological regression is inversely associated with Sentinel Lymph Node positivity.
03 Sep Neurons In Brain Most Affected by Alcohol Identified
MedicalResearch.com Interview with:
Dr. Jun Wang MD PhD, Assistant Professor
Department of Neuroscience and Experimental Therapeutics
Interdisciplinary Program in Neuroscience
Texas A&M College of Medicine
Medical Research: What is the background for this study?
Dr. Wang: Alcohol use disorder is a very common disease, but the mechanism is not clear and the treatment is limited.
Medical Research: What are the main findings?
Dr. Wang: We have three findings in an animal model of alcoholism:
- Alcohol drinking changes brain cells (also called neurons), making them more excitable.
- The change occurs only in a group of neuron called D1-neurons.
- Suppressing D1-neurons in a sub-region of the brain reduces excessive alcohol intake.
03 Sep Protein Keratin Promotes Cancer Growth and Chemotherapy Resistance
MedicalResearch.com Interview with:
Kenneth R. Shroyer, MD, PhD
The Marvin Kuschner Professor and Chair
Department of Pathology
Stony Brook Medicine
Stony Brook, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Shroyer: Patients that appear to have the same type of cancer often respond very differently to treatment; while some patients appear to go into long-term regression or are cured, others follow a rapid downhill course and ultimately die of their disease. This suggests that there are fundamental differences between tumors at the biologic level that are not detected by current clinical measures.
In this study, we report the unexpected finding that cancer patients that have high levels of a protein called Keratin 17 (K17) have decreased long-term survival when compared to patients that express little to no K17 in their tumors. In addition, we found that K17 enters the nucleus of tumor cells to mediate the degradation of the master regulator of cell division and tumor growth key tumor suppressor protein, p27. Furthermore, we identified that K17 increases the resistance of tumor cells to chemotherapy.
These are critical findings because this is the first report that a keratin is an oncoprotein that can enter the nucleus to promote the development of cancer and resistance to chemotherapy.
03 Sep Melatonin Did Not Improve Fatigue in Cancer Patients
MedicalResearch.com Interview with: Charlotte Lund Rasmussen Research Unit, Department of Palliative Medicine Bispebjerg Hospital, Copenhagen, Denmark Medical Research: What is the background for this study? What are the main findings? Response: We see that patients with advanced cancer often suffer from fatigue, pain, depression, insomnia and other symptoms, which can have a profound impact on quality of life. Melatonin is a neurohormone and its secretion is closely tied to the circadian rhythm making it a regulator of the sleep-cycle. Studies have shown that cancer patients have lower levels of melatonin than healthy controls, which may contribute to their fatigue and lowered quality of life. Furthermore, previous studies have found a possible effect of melatonin in cancer therapy, and non-clinical trials have shown melatonin to inhibit cell division in tumors. To our knowledge, no trials to date have investigated the effects of melatonin on fatigue. Given the role of melatonin in the sleep cycle, the lowered levels of melatonin noted among cancer patients, and results from previous studies, we wanted to investigate melatonin’s effect on fatigue among patients with advanced cancer. The primary objective of our study was to determine whether oral melatonin administered at night would reduce physical fatigue in patients with advanced cancer who were being treated in a palliative care facility. The effect of melatonin on other cancer-related symptoms including mental fatigue, insomnia, pain, emotional function, loss of appetite, and overall QoL were also investigated. In this trial we tested a dose of 20 mg of melatonin taken orally at night. However, melatonin did not improve physical fatigue in patients with advanced cancer. Furthermore, we were unable to identify improvements in any other cancer-related symptoms.03 Sep Telemedicine May Help Patients Adopt Healthy Lifestyle and Manage Chronic Diseases
MedicalResearch.com Interview with:
Dr. Rashid Bashshur PhD
Director of Telemedicine
University of Michigan Health System
Emeritus Professor of Health Management and Policy
University of Michigan, School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Bashshur: The impetus for this research derives from the confluence of several factors, including the increasing incidence and prevalence of chronic diseases, their associated morbidity and mortality and their high cost. The search for solutions has taken center stage in health policy. Patients must be engaged in in managing their health and health care, and they must assume greater responsibility for adopting and maintaining a healthy life style to reduce their dependence on the health system and to help themselves in maintaining an optimal level of health. The telemedicine intervention promises to address all these issues and concerns, while also providing ongoing monitoring and guidance for patients who suffer from serious chronic illness.
The preponderance of the evidence from robust scientific studies points to the beneficial effects of the telemedicine intervention (through telemonitoring and patient engagement) in terms of reduction in use of service (including hospital admissions/readmissions, length of hospital stay, and emergency department visits) as well as improved health outcomes. The single exception was reported in a study among frail elderly patients with co-morbidities who did not benefit from the telemedicine intervention.
There is an ever-growing and complex body of empirical evidence that attests to the potential of telemedicine for addressing the triad problems of limited access to care, uneven distribution of quality across communities, and cost inflation. Research demonstrates the effectiveness of the telemedicine intervention in addressing all three problems, especially when patients are engaged in managing their personal health and healthcare. The enabling technology can be used to promote healthy life styles, informed decision making, and prudent use of health resources.
Unintended consequences of delaying mortality for older adults may also increase the use of resources, especially in the long run, and society must decide on the ultimate values it chooses to promote.
03 Sep Healthy Diet Not Cure-All For Depression
MedicalResearch.com Interview with:
Dr. Mila Kingsbury PhD
Senior Research Associate at Department of Epidemiology and Community Medicine
University of Ottawa
Medical Research: What is the background for this study?
Dr. Kingsbury: Eating a healthy diet, including enough fruits and vegetables, is good for physical health, and some evidence suggests that it may be good for mental health, too. Specifically, intake of fruits and vegetables has been associated with lower risk of depression.
However, there are very few longitudinal studies on this topic. Most studies haven’t accounted for the effects of other related lifestyle factors such as smoking and exercise, nor for the fact that the links between lifestyle and mental health are bidirectional (i.e., depression can also hinder our ability to engage in healthy behaviours).
Medical Research: What are the main findings?
Dr. Kingsbury: While we found an association between fruit and vegetable consumption and psychological distress and depression two years later, depression and distress also predicted future fruit and vegetable consumption. Importantly, these associations became non-significant when we controlled for lifestyle factors like smoking and exercise.
02 Sep “Happy Meal” Law Would Decrease Fat, Sugar, Salt and Calories in Kids’ Meals
MedicalResearch.com Interview with:
Brian D. Elbel, PhD, MPH
Associate professor, Departments of Population Health, Division of Health and Behavior and Medicine, Division of General Internal Medicine
Marie Bragg, PhD
Assistant professorDepartment of Population Health
Jonathan Cantor, MS
Department of Population Health, Section on Health Choice, Policy and Evaluation
NYU Langone Medical Center
MedicalResearch: What is the background for this study?
Response: On July 17th, 2014 the New York City Council proposed the “Healthy Happy Meals” bill in an effort to improve the nutritional value of fast food restaurant meals marketed to children. The bill states a restaurant cannot offer an incentive item (i.e. a toy) in combination with the purchase of a meal unless the meal met several nutritional standards.
The meals with toys would be required to:
- Be less than 500 hundred calories total
- Be less than 600 milligrams of sodium total
- Have less than 35% of total calories come from fat
- Have less than 10% of total calories come from saturated fat
- Have less than 10% of total calories come from added sugar
- Contain one half cup of fruit or vegetable or one serving of whole-grain products
02 Sep Poor Patients Receiving Care Through Ryan White Programs Achieve Better HIV Control
MedicalResearch.com Interview with:
Dr. John Weiser MD MPH
Medical epidemiologist
Division of HIV/AIDS Prevention
CDC
Medical Research: What is the background for this study? What are the main findings?
Dr. Weiser: Ryan White was an Indiana teenager diagnosed with AIDS in the late 1980s. As a result of fear and stigma, he was barred from school and went on to become a national advocate for HIV education and acceptance. This year marks the 25th anniversary of his death and passage of the Ryan White CARE Act creating The Ryan White HIV/AIDS Program (RWHAP) which provides funding for healthcare facilities to deliver needed medical care and support services for hundreds of thousands of poor, uninsured, and underinsured Americans. While increased access to Medicaid and private insurance under the Affordable Care Act will provide coverage for medical care, it might not provide coverage for support services so it is likely that the RWHAP will continue to play a key role in providing these crucial services.
Overall, 34.4 percent of facilities received Ryan White HIV/AIDS Program funding and 72.8 percent of patients received care at RWHAP-funded facilities. Many of the patients at Ryan White HIV/AIDS Program -funded facilities had multiple social determinants of poor health, with patients at RWHAP-funded facilities more likely to be ages 18 to 29; female; black or Hispanic; have less than a high school education; income at or below the poverty level; and lack health care coverage.
Despite the greater likelihood of poverty, unstable housing and lack of health care coverage, nearly 75 percent of patients receiving care at RWHAP-funded facilities achieved viral suppression. The percentage of ART (antiretroviral therapy) prescribing was similar for patients at RWHAP-funded compared with non-funded facilities. Patients at RWHAP-funded facilities were less likely to be virally suppressed. However, individuals at or below the poverty level and those ages 30 to 39 who received care at a RWHAP-funded facility compared with those who received care at a non-RWHAP-funded facility were more likely to achieve viral suppression.
02 Sep Distance From Hospital Linked To Worse 30-Day Cardiac Surgery Outcomes
MedicalResearch.com Interview with:
Dr. Ansar Hassan MD PhD
Department of Cardiac Surgery
New Brunswick Heart Centre
Saint John Regional Hospital
Saint John, New Brunswick
Medical Research: What is the background for this study? What are the main findings?
Dr. Hassan: For years, geographic place of residence and one’s proximity to a tertiary care center has been identified as a predictor for access to care. Little is known regarding the effect of geography on patient outcomes. The purpose of this study was to explore the relationship between geography and in-hospital / 30-day outcomes among patients undergoing cardiac surgery. What we found was that despite there being no relationship between geography and in-hospital outcomes, those who lived further away from hospital clearly had worse 30-day outcomes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Hassan: While patients from a differing geographic places of residence appear to have similar in-hospital outcomes following cardiac surgery, their clinical courses following discharge from hospital differ considerably. Clinicians and patients need to realize that where one lives is tremendously important as it relates to his or her health and that particular attention needs to be paid to cardiac surgery patients who live further away from their tertiary care center, especially within the first 30 days following surgery.
02 Sep Gene Variant May Explain Why Some Children Respond More Aggressively To Stress
MedicalResearch.com Interview with:
Beate W. Hygen PhD Student
Department of Psychology
Norwegian University of Science and Technology Social Science
Medical Research: What is the background for this study?
Response: The study is part of the Trondheim Early Secure Study (TESS) conducted at the Department of Psychology, Norwegian University of Science and Technology (NTNU) and NTNU Social Science. The main aim of TESS is to detect risk and protective factors with regards to children’s mental health and well-being. TESS examines multiple factors which may play a role in children`s development.
There is substantial research, based on diathesis-stress theorizing, indicating that some individuals, including children, are more susceptible to the negative effects of contextual adversity than are others. However, according to differential susceptibility theory, such "vulnerable" individuals may also be the ones that benefit the most from positive environmental conditions. Thus, some individuals are more malleable for "better and for worse" to environmental exposures. The article Child exposure to serious life events, COMT, and aggression: Testing differential susceptibility theory was designed to examine if the COMT polymorphism moderated the effect of early-life adversity on aggressive behavior. Thus, we sought to competitively evaluate which model of person X environment interaction best accounted for the anticipated differential effects of life event stress on children's aggressive behavior.
02 Sep Cancer Driver Log Facilitates Precision Medicine, Linking Providers With Genetic Data Bank
MedicalResearch.com Interview with:
Sameek Roychowdhury, MD, PhD
Assistant Professor, Internal Medicine, College of Medicine
Assistant Professor, Department of Pharmacology
College of Pharmacy
Department of Internal Medicine
Division of Medical Oncology
Wexner Medical Center
The Ohio State University
Medical Research: What is the background for this study? What are the main findings?
Dr. Roychowdhury: Precision cancer medicine is a new paradigm to match patients to therapies based on the molecular alterations in their cancer. Novel genomic testing of cancer using next generation sequencing can reveal numerous mutations for each patient across many genes and types of cancer, and this requires detailed time-intensive interpretation. Driver mutations can confer a selective growth or survival advantage to cancer cells, while passenger mutations do not.
Cancer Driver Log, or CanDL, is meant to aid interpretation of mutations by providing the latest literature evidence for individual driver mutations, and thereby aiding pathologists, lab directors, and oncologists in interpreting mutations found in their patient’s cancer.
02 Sep Serious Injuries Rise As Older Age Groups Takes Up Cycling
MedicalResearch.com Interview with:
Benjamin N. Breyer MD, MAS, FACS
Associate Professor in Residence
Department of Urology
University of California, San Francisco
Chief of Urology, San Francisco General Hospital
Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship
Medical Research: What is the background for this study? What are the main findings?
Dr. Breyer: Our group has studied genitourinary-specific injuries associated with bicycles using a national surveillance injury database called NEISS (National Electronic Injury Surveillance System), that monitors injuries associated with specific products. In the current study, we examined trends in all bicycle-related injuries from 1997 to 2013. We found an increase in bicycle-related injuries over the study period, even after adjusting for growth in the US population. Even more concerning, we found the percentage of bicycle-related injuries resulting in admission increased 120%, suggesting the injuries sustained while cycling are becoming more severe. These trends appear to be driven by a substantial rise in both injuries and admissions in individuals over 45 years of age, which likely reflects a change in the demographic of cyclists in the US - multiple studies have shown an increase in the cycling participation of adults over the age of 45.
Bicycles are no longer children's toys - they are increasingly being used by adults as a means of transportation and physical activity. The rise in cycling in adults over the age 45 appears to be driving both the increase in injuries and admissions, suggesting that older individuals are at increased risk for sustaining severe injury while cycling.
02 Sep Genetic Signatures May Lead To Precision Treatments For Childhood Brain Tumors
Medicalresearch.com Interview with:
Roger Packer MD
Senior Vice President
Center for Neuroscience & Behavioral Health
Children's National Medical Center
Washington, D.C.
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Packer: The background is that medulloblastoma is the most common childhood malignant brain tumor. It carries with it a variable prognosis. For some subsets of patients, with current available treatment which includes surgery, radiation and chemotherapy, we see survival rates as high as 90% (and often cures) 5 years following diagnosis and treatment. However, for some subsets of patients, survival rates are much poorer, in those with higher risk characteristics as low as 40% at 5 years. Current treatment also carries with it a significant risk for long term sequelae, including intellectual loss secondary to radiation therapy and persistent, at times devastating neurologic complications such as unsteadiness.
To try to improve our understanding and ultimately our therapy for medulloblastoma, an international working group has shared patient specimens and patient information to attempt to determine what the molecular predictors of outcome are for children with medulloblastoma and if such molecular genetic findings can be used to develop better, safer therapies. Children’s National is part of this international collective of institutions, which published this and other studies.
The main findings of this study are that complex, integrated genetic analysis of tumor specimens can be used to better understand and set the scene for better treatment of medulloblastoma. Medulloblastoma can be broken into relatively distinct, molecular subtypes each with its own prognosis and potential therapy. A major finding of this study was that within a given tumor, different areas showed the same molecular genetic pattern. The importance of this is that since the tumors are relatively the same in different areas, molecularly-targeted therapies have an excellent chance of working on the entire tumor, resulting in better tumor control and safer treatments.
01 Sep Data-Driven Model Can Help Predict Hospital Discharges
MedicalResearch.com Interview with:
Dr. Sean Barnes Ph.D.
Department of Decision, Operations & Information Technologies
Robert H. Smith School of Business
University of Maryland, College Park, MD
Medical Research: What is the background for this study? What are the main findings?
Dr. Barnes: Hospitals are continually being challenged to provide timely and efficient care in the face of increasingly constrained resources. One recent approach to help improve patient flow in hospitals is Real-Time Demand and Capacity Management, by which clinicians huddle each morning to predict the number of patients they expect to discharge on a given day (and hence the number of beds that will become available to potentially utilize for newly admitted patients). We proposed a data-driven method for predicting discharges--either on an individual or aggregate basis--and demonstrated that we could match or exceed the predictive accuracy of clinicians. In addition, we showed (with moderate success) that we could use this model to rank patients in order of their expected discharge times, which could be used to prioritize the remaining care tasks for specific subsets of patients.
01 Sep Risky Decision Making May Run in Families Prone To Suicide
MedicalResearch.com Interview with:
Fabrice Jollant, MD, PhD
McGill University, Department of Psychiatry
& Douglas Mental Health University Institute
McGill Group for Suicide Studies
Montréal (Québec), Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Jollant: Suicide takes almost 1 million lives each year worldwide. Improving suicide prevention necessitates improving our understanding of the mechanisms leading to these complex acts. We know that while many people who died from suicide had experienced negative life events (divorce, job loss, grief), most people who experience these events will not commit suicide, not even think about suicide. Similarly, while more than 90% of suicide completers had suffered a major mental disorders (mainly depression and substance abuse) and treating these mental disorders can reduce suicide rates, 90% of patients will never die from suicide. Thus, research focuses now on the specific factors that make some individuals more vulnerable. We previously found that individuals who attempted suicide are more likely to make risky choices at a gambling task than patients who went through depression but never attempted suicide. They tend to choose the options that yield more gains immediately but are long-term disadvantageous. People who choose this way are also more likely to have problems in their interpersonal relationships, a classic trigger of suicidal crisis.
Medical Research: What are the main findings?
Dr. Jollant: This study continues our previous series of investigations. Here, we assessed decision-making in close biological relatives of suicide completers. We know that suicide is heritable and can run within some families. So, we were interested in knowing if risky decision-making could be one factor transmitted within families of suicide completers. We recruited healthy individuals who had lost a close biological relative from suicide, but never attempted suicide themselves. We found that these persons also tend to choose the riskiest options. However, we could not find some other cognitive deficits previously found in suicide attempters, e.g. deficient cognitive control. These normal cognitions may therefore counterbalance their deficits in decision-making and maybe protect them against suicide.
01 Sep Study Examines Safety Climate and Support Within Cardiac Surgical Teams
Posted at 20:34h
in Author Interviews, Heart Disease, Johns Hopkins, Outcomes & Safety, Surgical Research
MedicalResearch.com Interview with:
Jill A. Marsteller, PhD, MPP
Department of Health Policy and Management,
Johns Hopkins Bloomberg School of Public Health
Baltimore, Maryland and
Juan A. Sanchez, MD, MPA, FACS, FACC
Associate Professor of Surgery
Associate Faculty, Armstrong Institute for Patient Safety and Quality
Johns Hopkins Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: The culture of healthcare organizations with regards to safety has an impact on patient outcomes. A strong culture serves as a platform for preventing medical errors. This study examines the culture of safety along several dimensions in cardiac surgical teams and compares this data to surgery of all types using a large database. In our study, cardiac surgery teams scored highest in teamwork and lowest in non-punitive responses to error. In addition, there was substantial variation on safety climate perception across team roles. For example, surgeons and support staff had higher perceptions of a safety climate than other team members. Compared to all types of surgery teams, cardiac surgery teams scored higher in overall perceptions of safety except for anesthesiologists who reported lower scores on communication about errors and communication openness.
01 Sep Finerenone Reduces Urine Protein Loss in Diabetic Kidney Disease
MedicalResearch.com Interview with:
George L. Bakris MD
Professor of Medicine
Director, Comprehensive Hypertension Center
University of Chicago Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Bakris: Aldosterone receptor antagonists such as spironolactone are known to reduce mortality from heart failure and reduce albuminuria, a well-known marker of diabetic kidney disease progression. Finerenone is a novel nonsteroidal aldosterone receptor antagonist and is associated with less hyperkalemia (high blood potassium levels) compared to traditional aldosterone receptor blockers like spironolactone. The current study was a dose finding study to ascertain the optimal dose of finerenone for reducing urine albumin (a key risk marker in people with diabetic kidney disease) that is also associated with the smallest rise in serum potassium. The main findings are that in a dose dependent manner finerenone reduced albuminuria and at the highest dose a modest rise in serum potassium. Finerenone was also very well tolerated.
01 Sep Recent Spike in Plague Cases in Western US
[caption id="attachment_17159" align="alignleft" width="300"]
The White-Throated Wood Rat, is a proven carrier of plague vector fleas.[/caption]
Medical Research: What is the background for this study? What are the main findings?
Response: Plague, a bacterial disease that is endemic to the Western United States, is most famous for the destruction it caused during the Middle Ages when it killed over half the population of Europe. Today, plague still infects people around the world and there are a handful of cases each year here in the U.S. However, this year where there are normally 3-7 cases, there have been 12 cases since the beginning of April.
Medical Research: What should clinicians and patients take away from your report?
Response: One of the main reasons CDC issued our report on this year’s plague cases was because we want to remind clinicians and their patients that plague should be considered as a diagnosis if the symptoms, travel history, and exposure fit. Most cases occur between late spring and early fall, so there might still be more cases this year. It’s good to be aware of three things: where cases occur, how the disease is spread, and how to prevent it.
- Most cases occur in the Western United States, and so far this year the cases have been from Arizona (two), California (one), Colorado (four), Georgia (one, but exposed in California), New Mexico (two), Oregon (one), and Utah (one).
- Plague is spread when fleas become infected by feeding on rodents, such as chipmunks, prairie dogs, ground squirrels, mice, and other mammals that are infected with the plague bacterium Yersinia pestis. Fleas then spread the plague bacteria to humans and other mammals during their next feeding.
- Most important, CDC recommends that people who live in or travel to the Western United States wear long pants when possible and use insect repellent on clothing and skin when outside. People also should avoid direct contact with ill or dead animals and never feed squirrels, chipmunks, or otherwild rodents. In addition, pet owners should regularly use flea control products on their pets and consult a veterinarian if their pet is ill. Rodent habitat can be reduced around the home by removing brush, clutter, and potential rodent food sources such as garbage or pet food. If you have any symptoms of plague, please see a clinician and let them know where you’ve traveled and if you’ve had contact with rodents.
01 Sep Breast Cancer Patients With Later Stage Disease More Like To Have Mastectomy
Posted at 13:36h
in Author Interviews, Breast Cancer, Brigham & Women's - Harvard, Surgical Research
MedicalResearch.com Interview with:
Dr. Rachel A Freedman MD MPH
Dana-Farber Cancer Institute
Assistant Professor of Medicine
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Freedman: Despite a lack of medical benefit for most patients, the rates for bilateral mastectomy (double mastectomy) are on the rise in the U.S. Many factors have been cited as potential reasons for this increase, such as one’s race/ethnicity, education level, family history, and use of MRI. Cancer stage has not consistently been a factor in past studies. In this study, we surveyed 487 women who were treated for breast cancer in Northern California within the California Cancer Registry, we examined factors associated with the type of surgery a woman received. In our study, we found strong associations for stage III cancer with receipt of unilateral and bilateral mastectomy. In addition, higher (vs. lower) income and older age were associated with lower odds of having bilateral surgery.
01 Sep Growth Hormone Reduced Fractures in Osteoporosis Patients
MedicalResearch.com Interview with: Emily Krantz (né Amundson) MD Södra Älvsborgs Hospital Borås, Sweden Medical Research: What is the background for this study? What are the main findings? Response: This study is a 10-year follow up of a double-blind placebo controlled trial in which women with post menopausal osteoporosis received Growth Hormone (GH) for 3 years (Landin-Wilhelmsen JBMR 2003;18:393-404). Positive effects of the treatment on the patients bone mineral density and bone mineral content were seen after another 7 years. Furthermore and most interestingly, fracture incidence decreased dramatically from 56% to 28% (p=.0003) in the osteoporosis patients while fractures increased significantly in the control group, from 8% to 32% (p=.0008). Health Related Quality of Life was also measured throughout the study’s duration and it did not change nor did it differ from the control group.01 Sep Some Heart Failure Patients Without AFib May Benefit From Anticoagulation
MedicalResearch.com Interview with:
Line Melgaard MSc. Industrial Medicine, PhD student
AALBORG Univerity Hospital
Thrombosis Research Center Aalborg
Aalborg Hospital Science and Innovation Center
Aalborg Denmark
Medical Research: What is the background for this study? What are the main findings?
Response: In recent years, use of the CHA2DS2-VASc score in predicting ischemic stroke, thromboembolism, and death has extended beyond the original disease state (atrial fibrillation) for which it was proposed. In addition, it is recognized that the cluster of multiple stroke risk factors included within the CHA2DS2-VASc score increases the risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation is present. Thus, there is a need to study the extent to which concomitant atrial fibrillation modifies the pattern of the association between CHA2DS2-VASc score and the risk of ischemic stroke, thromboembolism, and death in patients with heart failure.
- Our principal findings were that patients with heart failure had a high risk of ischemic stroke, thromboembolism, and death, whether or not atrial fibrillation was present.
- Second, the CHA2DS2-VASc score was able to modestly predict these endpoints, and had a moderately high negative predictive value at 1-year follow-up.
- Third, at high CHA2DS2-VASc scores (≥4), patients with heart failure without atrial fibrillation had high absolute risk of ischemic stroke, thromboembolism, and death, and the absolute risk increased in a comparable manner in patients with heart failure with and without atrial fibrillation, exhibiting a clear dose-response relationship. Indeed, the absolute risk of thromboembolic complications was higher among patients without atrial fibrillation compared to patients with concomitant atrial fibrillation at high CHA2DS2-VASc score (≥4).
01 Sep Arterial Catheters Remain Source of Hospital Associated Infections
Posted at 12:02h
in Author Interviews, Critical Care - Intensive Care - ICUs, Infections, Outcomes & Safety
MedicalResearch.com Interview with:
Leonard Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP
Professor of Medicine, Warren Alpert Medical School of Brown University
Medical Director, Dept. of Epidemiology & Infection Control, Rhode Island Hospital
Adjunct Clinical Professor, University of Rhode Island College of Pharmacy
Medical Research: What is the background for this study? What are the main findings?
Dr. Mermel: Arterial catheters are an under recognized source of hospital-associated bloodstream infection. As a result, arterial catheter infection prevention strategies are less well studied than with central lines. We did a national survey and our findings reaffirmed the fact that physicians using these catheters underestimate the risk of infection. Additionally and not surprisingly, infection prevention strategies are variable particularly concerning barrier precautions at insertion.
Medical Research: What should clinicians and patients take away from your report?
Dr. Mermel: Arterial catheters can cause catheter-related bloodstream infections. These devices should be aseptically inserted and managed post-insertion and removed as soon as no longer required for patient care. We are also in need of better studies to clearly delineate the ideal infection prevention strategies with these catheters based on our understanding of the pathogenesis of such infections.
01 Sep Breastfeeding May Reduce Multiple Sclerosis Relapses
MedicalResearch.com Interview with:
PD Dr. Kerstin Hellwig
Neurologische Abteilung Universitätsklinikum
St. Josef Hospital
Bochum
Medical Research: What is the background for this study? What are the main findings?
Dr. Hellwig: The relapse risk is elevated in women with Multiple Sclerosis after delivery. We found that women with Multiple Sclerosis who breastfed exclusively had a significant lower relapse risk, than women who did not breastfed at all or breastfed some
but not exclusively. After the introduction of supplemental feedings,
the relase risk was similar between both groups.
31 Aug Abdominal Obesity Raises Risk of Breast Cancer in Pre and Post Menopausal Women
MedicalResearch.com Interview with:
Dr. Alexandra White PhD in Epidemiology
University of North Carolina at Chapel Hill
Postdoctoral fellow
National Institute of Environmental Health Science
MedicalResearch: What is the background for this study?
Dr. White: Many studies have shown that being overweight or obese is a risk factor for postmenopausal breast cancer. We know less about how obesity impacts breast cancer risk in premenopausal women.
About a third of U.S. adults are obese, which is defined as having a body mass index (BMI) greater than 30. Similarly, the prevalence of abdominal obesity, measured by a person’s waist circumference, has increased by 10% in the last decade. In 2012, more than two-thirds of U.S. women had a waist circumference that indicated abdominal obesity.
Abdominal obesity may be a better predictor than BMI for breast cancer risk and other chronic diseases, because it is related to insulin resistance and can reflect metabolically active fat stores.
In order to understand how different types of obesity (overall vs. abdominal) influence breast cancer risk, we used information from >50,000 participants in the Sister Study. The Sister Study, led by scientists at the National Institute of Environmental Health Sciences, part of the National Institutes of Health investigates environmental and genetic risk factors for breast cancer.
31 Aug Study Reports High Prevalence of Military Sexual Trauma Among Recent Veterans
MedicalResearch.com Interview with:
Shannon K. Barth MPH
Department of Veterans Affairs
Office of Public Health, Post Deployment Health
Epidemiology Program
Washington, District of Columbia
Medical Research: What is the background for this study?
Response: This study used data from the “National Health Study for a New Generation of U.S. Veterans,” a population-based health study of 20,563 Operation Iraqi Freedom and Operation Enduring Freedom Veterans and their non-deployed counterparts, conducted in 2009-2011. A two-question measure of sexual harassment and sexual assault based on an existing clinical screen used by Veterans Health Administration (VHA) providers was included on the survey. Consistent with use in clinical settings, a veteran was considered to have experienced MST if they responded affirmatively to either of the two questions. While estimates of the prevalence of MST based on the clinical screener are available, these estimates only provide information about veterans who use VHA services and may not generalize to the broader OEF/OIF veteran population. This new survey provides a unique opportunity to assess MST experiences among a representative sample of OEF/OIF veterans in a confidential setting. Additionally, we were able to assess responses to the sexual harassment and sexual assault questions separately and collectively.
Medical Research: What are the main findings?
Response: The main findings from our study are that 41% of women and 4% of men reported experiencing MST. Veterans who reported using VHA services had a higher risk of MST compared to those who didn’t receive VHA services. The relationship between deployment to OEF/OIF and experiencing MST differed between men and women. Combat-exposed veterans had greater risk of reporting MST compared to those not exposed to combat, while controlling for deployment status.
Among women, approximately 10% reported experiencing sexual assault. In contrast, 0.5% of male participants reported experiencing sexual assault.
31 Aug Algorithm Attempts To Overcome Medical Intolerance In Hypertensive Patients
MedicalResearch.com Interview with:
Dr M Lobo PhD FRCP
Director Barts BP Centre of Excellence
Consultant Physician and Hon Senior Lecturer
NIHR Barts Cardiovascular Biomedical Research Unit
William Harvey Research Institute, London
Medical Research: What hypothesis did you set out to investigate and why?
Dr. Lobo: We investigated the clinical utility of a novel treatment algorithm for multi-drug intolerant patients with hypertension who are at very high risk of cardiovascular disease due to uncontrolled blood pressure and inability to take conventional (guideline-based) antihypertensive regiments. These patients are often poorly managed by primary care physicians (or specialists such as cardiologists) because there has been little interest/research in medication intolerance. There has however been a major focus on drug non-adherence as a cause of failure to control hypertension - we believe that a key cause of non-adherence is medication intolerance which patients do not always volunteer.
Medical Research: What is the report's ultimate take-away message?
Dr. Lobo: Our novel stepwise algorithm was successful in managing uncontrolled hypertension in the majority of patients without needing an increase in their medicines burden. The message therefore is that patients who do not tolerate their antihypertensives do not have to put up with side effects and resultant poor quality of life as we have demonstrated that there are ways to get around medication intolerances.
31 Aug ID Badges and Lanyards Appear To Have Low Risk of Viral Spread In Hospitals
MedicalResearch.com Interview with:
Daryl R. Cheng, MBBS
Monash Children's Hospital
Victoria, Australia
Medical Research: What is the background for this study? What are the main findings?
Response: Inanimate objects worn and used by health care workers (HCW), such as neckties and stethoscopes, have been shown to be reservoirs for potential pathogens. Of particular concern in the pediatric setting are identity (ID) badges and lanyards.
Many pediatric health care workers use them not only for
identification but also as a distraction tool during examination or procedures. Children have an increased tendency to place these items in their mouth as health care workers lean over to examine or care for them, therefore completing the chain of transmission for a potential nosocomial infection.
Whilst previous studies have demonstrated that ID badges and lanyards worn by health care workers may harbor pathogenic bacteria , there is paucity of comparative data suggesting that ID badges may be similarly contaminated with viral pathogens.
However, given the higher incidence of viral infections in pediatrics up to 50% of preterm infants screened during their hospital stay y had viruses detected in their nasopharynx, further evaluation of the viral burden and potential for nosocomial transmission of prevalent viruses are of both clinical and economic significance.