Author Interviews, Depression, Heart Disease, Statins / 07.03.2015

Heidi May, Ph.D., M.S.P.H. Cardiovascular Epidemiologist Intermountain Medical Center Heart Institute Salt Lake CityMedicalResearch.com Interview with: Heidi May, Ph.D., M.S.P.H. Cardiovascular Epidemiologist Intermountain Medical Center Heart Institute Salt Lake City   Medical Research: What is the background for this study? What are the main findings? Dr. Heidi May: Cardiovascular disease remains the leading cause of morbidity and mortality worldwide. Statin therapy is known to reduce the risk of cardiovascular disease incidence through the reduction of blood cholesterol levels and through its pleiotropic cardioprotective properties. Depression is a risk factor for cardiovascular disease. It has been recommended that antidepressant medications should be considered first-line treatment for depression of any severity. We hypothesized that taking both statins and antidepressants would reduce cardiovascular risk more than either medication alone. However, we did not find this. Instead we found that the effectiveness of antidepressants and statin therapy to reduce death and incident cardiovascular disease at 3 years varied by the severity of depressive symptoms. Among those with none to mild depressive symptoms, statin use, with or without antidepressant therapy, was associated with a decrease in risk, but among those with moderate to severe depression, antidepressant use was associated with a decrease in risk. The combination of antidepressant and statin use did not result in a greater risk reduction in either depressive symptom category. (more…)
Author Interviews, OBGYNE, Toxin Research, University of Pittsburgh / 07.03.2015

Dr. Jennifer Adibi, MPH ScD University of Pittsburgh, Public Health Assistant Professor, Epidemiology Assistant Professor, Department of Obstetrics/Gynecology and Reproductive Sciences Affiliate, Department of Obstetrics/Gynecology and Reproductive Sciences University of California, San FranciscoMedicalResearch.com Interview with: Dr. Jennifer Adibi, MPH ScD University of Pittsburgh, Public Health Assistant Professor, Epidemiology Assistant Professor, Department of Obstetrics/Gynecology and Reproductive Sciences Affiliate, Dept. of ObGYN and Reproductive Sciences University of California, San Francisco Medical Research: What is the background for this study? Dr. Adibi: Prenatal exposure to phthalates in rodents can cause defects in male sexual development including a shorter distance between the anus and the genitalia (anogenital distance or AGD).  Human studies have shown a correlation between higher prenatal phthalate urinary concentrations in the mother and shorter AGD in males.  AGD in males is related to fertility and reproductive health over the lifetime.  In females, AGD was associated with numbers of ovarian follicles.  The role of the placenta has not been considered in these studies. A  placental hormone called human chorionic gonadotropin (hCG) is essential for normal male development. Our previous research has shown that hCG expression by human placental cells is disrupted by phthalate concentrations equal to what we measured in maternal urine.  The placenta secretes molecules early in pregnancy that might provide an opportunity to detect these effects in humans. Medical Research: What are the main findings? Dr. Adibi:  In 350 pregnancies, we measured a significant association of maternal urinary concentrations of mono-n-butyl phthalate (MnBP) and monobenzyl phthalate (MBzP) with hCG in maternal blood in the first trimester.  Higher phthalate concentrations were associated with higher hCG if the mother was carrying a female fetus, and lower concentrations if she was carrying a male fetus.  In a high/low MnBP comparison, hCG was 15-fold higher in the higher exposed female fetuses.  We also observed a relationship between maternal levels of hCG in the first trimester and anogenital distance in the newborns.  The correlation was positive in female newborns, and inverse in male newborns. Similar to the parent study, we observed associations of higher first trimester MnBP and mono-2-ethyl hexyl phthalate (MEHP) with lower male anogenital distance.  If we combined these findings into a mediation analysis, we estimated that approximately 20-30% of the phthalate-induced effect on anogenital distance was due to the phthalate disruption of hCG. (more…)
AHA Journals, Author Interviews, CDC, Salt-Sodium / 07.03.2015

Dr. Sandra L. Jackson, Ph.D., M.P.H Epidemic intelligence service fellow Centers for Disease Control and Prevention, Chamblee, GAMedicalResearch.com Interview with: Dr. Sandra L. Jackson, Ph.D., M.P.H Epidemic intelligence service fellow Centers for Disease Control and Prevention, Chamblee, GA Medical Research: What is the background for this study? What are the main findings? Dr. Jackson: With more than 90 percent of U.S. adults exceeding recommended sodium intake levels, healthcare providers can play a key role in counseling patients on the importance of limiting salt in the diet. To assess the impact of medical advice on an individual’s efforts to reduce sodium intake, CDC researchers examined self-reported telephone survey information from nearly 174,000 U.S. adults. Overall, more than half of the respondents reported watching or reducing their sodium intake in 2013 – but less than one quarter (23 percent) said they received advice from a doctor or healthcare professional about sodium reduction. Of those that received the medical advice, 82 percent reported taking action to limit their sodium intake. In comparison, only 44 percent of respondents who reported not receiving medical advice said they took steps to reduce sodium. The substantial proportion of patients who are not receiving medical advice (77%), according to these findings, reveals a missed opportunity to reduce sodium intake, particularly among groups that have a higher risk of developing cardiovascular disease. This includes African Americans, and those with high blood pressure, diabetes or chronic kidney disease. (more…)
Author Interviews, Dermatology, Melanoma / 06.03.2015

MedicalResearch.com Interview with: Alberto Pappo, M.D. Member, Oncology; Director, Solid Tumor Division St. Jude Children’s Research Hospital Medical Research: What is the background for this study? What are the main findings? Dr. Pappo: Researchers have identified three distinct subtypes of childhood and adolescent tumors of pigment-producing skin cells called melanocytes. The subtypes have different genetic alterations and often different outcomes for patients. The findings should aid efforts to improve diagnosis and treatment of melanoma, which is the most common skin cancer in children and adolescents. The study provides the most comprehensive analysis yet of the genetic alteration underlying pediatric melanoma, including the first genetic evidence that sun damage causes melanoma in children and adolescents as well as adults. Researchers used whole genome sequencing and other techniques to study the normal and cancer genomes of 23 young patients with a variety of melanocytic tumors, including conventional melanoma. Patients ranged in age from 9 months to 19 years old. The melanoma subtypes in this study included conventional melanoma, which scientists showed was the same disease in children, adolescents and adults. More than 90 percent of pediatric conventional melanoma had DNA changes linked to sun damage. (more…)
AHA Journals, Author Interviews, Heart Disease, Social Issues / 06.03.2015

Randy Cohen, MD, MS, FACC Division of Cardiology Mt. Sinai St. Luke's Hospital New York, NYMedicalResearch.com Interview with: Randy Cohen, MD, MS, FACC Division of Cardiology Mt. Sinai St. Luke's Hospital New York, NY MedicalResearch: What is the background for this study? Dr. Cohen: Psychosocial conditions such as depression, anxiety, chronic stress and social isolation have strong associations with heart disease and mortality. Recently, however, attention has focused on positive emotions, psychological health and their collective impact on overall health and well-being.   Purpose in life is considered a basic psychological need, and has been defined as a sense of meaning and direction in one’s life which gives the feeling that life is worth living. We performed a meta-analysis of prospective studies evaluating the relationship between having a sense of purpose in life, mortality and cardiovascular disease. MedicalResearch: What are the main findings? Dr. Cohen: We identified 10 prospective studies involving over 137,000 subjects and found that possessing a sense of purpose in life was associated with a 23% reduced risk for all-cause mortality and a 19% reduced risk for cardiovascular disease events. (more…)
Author Interviews, Heart Disease, Menopause, University of Pittsburgh, Women's Heart Health / 06.03.2015

Dr. Rebecca Clark Thurston Ph.D Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science University of PittsburghMedicalResearch.com Interview with: Dr. Rebecca Clark Thurston Ph.D Associate Professor of Psychiatry, Epidemiology, Psychology, and Clinical and Translational Science University of Pittsburgh   MedicalResearch: What is the background for these studies? What are the main findings? Dr. Clark Thurston: The understanding of women’s cardiovascular disease and the role that reproductive factors play in women’s cardiovascular health is evolving. There are some studies showing links between menopausal hot flashes and cardiovascular disease risk in women. These studies help further refine this understanding. We showed in two separate studies that women who have hot flashes, particularly frequent hot flashes early in midlife, have poorer vascular health on certain indices. (more…)
Author Interviews, Nutrition, Weight Research / 06.03.2015

Frances M. Sladek, Ph.D. Professor of Cell Biology and Toxicologist Associate Director, UCR Stem Cell Center Department of Cell Biology and Neuroscience University of California Riverside, CA 92521-0314MedicalResearch.com Interview with: Frances M. Sladek, Ph.D. Professor of Cell Biology and Toxicologist Associate Director, UCR Stem Cell Center Department of Cell Biology and Neuroscience University of California Riverside, CA 92521-0314 Medical Research: What is the background for this study? What are the main findings? Dr. Sladek: In 2011 Blasbalg et al reported in the American Journal of Clinical Nutrition that the consumption of soybean oil was the component of the American diet that had changed the most since the early 1900s. It had in fact increased 1000-fold. Soybean oil is currently not only the main type of vegetable oil used in the U.S. but soybean meal is a major component of the diet of the animals such as cows and pigs, resulting in changes in the fatty acid composition of animal fat. Soybean oil is also increasingly being used worldwide: 40 million tons were produced in 2007 alone. In our previous study we found that a high fat diet containing comparable amounts of soybean oil to what Americans are currently consuming caused mice to become obese, diabetic and insulin resistant and to have large lipid droplets and hepatocyte ballooning in their livers. Others had found similar results and proposed that linoleic acid (an omega 6 polyunsaturated fat) that makes up >55% of the oil was responsible for the negative metabolic effects. DuPont recently generated a genetically modified  soybean oil  that had reduced levels of linoleic acid and hence less of a tendency to generate trans fats. This oil (called Plenish) came onto the market for the first time in 2014. The fatty acid composition of Plenish is similar to that of olive oil (low linoleic acid and high oleic acid), which is a major component of the healthy Mediterranean diet. The implication, therefore, is that Plenish is healthier than conventional soybean oil but that has not been formally proven. In the current study, we found that while a high fat diet containing Plenish also induced obesity, glucose intolerance and fatty liver, it did not induce insulin resistance as did the conventional soybean oil. It also induced somewhat less fat accumulation. Finally, we compared the diet enriched in soybean oil to an isocaloric diet that contained the same amount of total fat (40%kcal, Americans consume 34-37% fat) but with 90% of the fat from coconut oil. Those animals gained very little weight (13% versus 38% with the conventional soybean oil and 30% with the Plenish) and were not diabetic or insulin resistant. Their livers also had less fat than either of the two soybean oil diets and showed no signs of hepatocyte ballooning. Coconut oil has essentially no linoleic acid or other PUFAs. Our results, assuming humans respond in the same way as mice, suggest that people should avoid the consumption of too much soybean oil, either conventional or Plenish. They also show that coconut oil, which is made up of saturated fats (primarily medium chain triglycerides), is much healthier for you than soybean oil. Coconut oil has been noted previously for its beneficial health effects. (more…)
Author Interviews, Endocrinology, Metabolic Syndrome, Nutrition, Pediatrics, UT Southwestern / 06.03.2015

Dr. Roy Kim, MD Depts. Endocrinology and Pediatrics UT Southwestern Medical CenterMedicalResearch.com Interview with: Dr. Roy Kim, MD Depts. Endocrinology and Pediatrics UT Southwestern Medical Center Medical Research: What was the problem you were focused on? Dr. Kim: We were focused on the problem of adolescent metabolic syndrome, a major public health problem. Our objective was to determine whether nut intake is linked with any difference in odds for metabolic syndrome in US adolescents. Medical Research: How is metabolic syndrome defined? Dr. Kim: In general it is diagnosed when there are 3 or more of the following things: increased belly fat, high blood pressure, high fasting glucose, elevated triglycerides, and low HDL cholesterol. Medical Research: How did you do your study? Dr. Kim: We used data from the National Health and Nutrition Examination Survey (NHANES), years 2003-2010, to examine health status and the diet history for 2,322 US adolescents age 12 to 19 years. Dr. Kim: Our first major finding was that adolescents who ate at least 12.9 grams of nuts per day - this is the equivalent of about 1 ounce of nuts 3 times per week – had a dramatically lower odds for metabolic syndrome compared to adolescents who ate less than that amount. The odds for nut-consumers was only about 43% of the odds for non-consumers. This remained true after controlling for age, gender, race, income, and dietary factors including sugar, fruit, and vegetable intake. Our second major finding was that average nut intake is very low among US adolescents – only about 5 grams per day - and more than 75% of US adolescents eat no nuts at all on a typical day. (more…)
Author Interviews, Diabetes, Neurological Disorders / 06.03.2015

Dr. John A Kessler MD The Ken and Ruth Davee Professor of Stem Cell Biology Department of Neurology Professor, Department of Pharmacology Northwestern University Feinberg School of MedicineMedicalResearch.com Interview with: Dr. John A Kessler MD The Ken and Ruth Davee Professor of Stem Cell Biology Department of Neurology Professor, Department of Pharmacology Northwestern University Feinberg School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Kessler: Painful diabetic neuropathy afflicts millions of patients. It interferes with sleep and many daily activities of living, and predisposes to depression. There is a loss of sensation in the legs which predisposes to foot/leg ulcers which may lead to amputation. The only currently available treatments, other than controlling glucose levels, are drugs including gabapentin, pregabalin, or antidepressants which have major side effects and which help only some patients. These are medications which must be taken daily or several times daily and are often poorly tolerated by patients. This study examined the effects of a nonviral gene therapy approach for using hepatocyte growth factor (HGF) to treat patients with painful diabetic neuropathy. HGF helps to support the health of neurons and it also helps to grow new blood vessels to support nerve function. Patients received two sets of treatments (injections) and were then followed for 9 months.  The treatment was exceptionally well tolerated -  literally without significant side effects. The patients had highly significant reductions in pain and improvement in the quality of life, and their ability to sense gentle pressure (touch) was improved. The benefits lasted months without additional treatment. (more…)
AHA Journals, Author Interviews, Exercise - Fitness, Weight Research / 05.03.2015

MedicalResearch.com Interview with Christopher C. Imes, PhD, RN Assistant Professor, Acute and Tertiary Care University of Pittsburgh, School of Nursing MedicalResearch: What is the background for this study? Dr. Imes: Increased physical activity (PA) with reduced energy intake is the key strategy to achieve weight loss. However, in research, there are challenges to obtaining accurate PA data. Many studies rely on self-report, which is easily accessible and inexpensive but is known to have numerous limitations. Pedometers are a relatively inexpensive and accessible method to objectively measure certain aspects of physical activity. The purpose of this analysis was to examine the associations between self-reported physical activity, pedometer step count data and weight loss during the first 6-months of the Self-Efficacy Lifestyle Focus (SELF) trial. All participants in this trial were instructed to reduce their calorie and fat intake, were encouraged to engage in at least 150 minutes of moderately intense PA/week or 7500 steps/day, and to self-monitor their diet and physical activity. MedicalResearch: What are the main findings? Dr. Imes: Change in self-reported physical activity from baseline to 6 months was not associated with weight change. However, average daily step count, derived from pedometers given to participants during the same time period, was associated with weight loss. More daily steps results in more weight loss. The participants who averaged over 7500 steps/day lost about 9.5% of their initial body weight; whereas, the participants who averaged less than 5000 steps/day only lost about 5.0%. (more…)
Author Interviews, Prostate Cancer / 05.03.2015

M. Minhaj Siddiqui, MD Director of Urologic Robotic Surgery Assistant Professor of Surgery - Urology University of Maryland School of Medicine Baltimore MD 21201MedicalResearch.com Interview with: M. Minhaj Siddiqui, MD Director of Urologic Robotic Surgery Assistant Professor of Surgery - Urology University of Maryland School of Medicine Baltimore MD 21201 Medical Research: What is the background for this study? Response: A history of testicular cancer has been suggested to have an association with an increased risk of developing prostate cancer (PCa) in epidemiologic studies. We hypothesized that there may be an increased risk of developing intermediate to high-risk prostate cancer as well. Medical Research: What are the main findings? Response: 147,044 men with melanoma and 32,435 men with testicular cancer were identified. Prostate cancer was diagnosed in 3,205 men in total. The cumulative incidence of all prostate cancer by age 80 was 2.8% in the control melanoma cohort and 12.6% in the case cohort of men with history of testicular cancer (p<0.0001 for KM survival curves, Figure 1). For intermediate/high-risk disease, the incidence was 1.1% versus 5.8% for each cohort respectively (p<0.0001 for KM survival curves, Figure 2). No association with prostate cancer was seen with non-seminomatous versus seminomatous germ cell tumors. Upon multivariate analysis, testis cancer was associated with an increased risk of all prostate cancer (HR 4.7, p<0.0001) and intermediate/high-risk PCa (HR 5.2, p<0.0001) when controlling for race and radiation history. (more…)
Author Interviews, Exercise - Fitness, Heart Disease / 05.03.2015

Prof. Scott Montgomery Prof. Montgomery is a clinical epidemiologist, conducting research in life-course influences on chronic disease risk Örebro UniveristyMedicalResearch.com Interview with: Prof. Scott Montgomery Prof. Montgomery is a clinical epidemiologist, conducting research in life-course influences on chronic disease risk Örebro Univeristy Medical Research: What is the background for this study? What are the main findings? Prof. Montgomery: Stress is thought to increase the risk of heart disease. However, an experience that is stressful for one person may not be so for another, as stress resilience varies. As we believe that stress resilience is influenced by childhood experiences, we examined whether teenagers with low stress resilience were more likely to have coronary heart disease in subsequent adulthood (they were followed to a maximum age of 58 years). In this study of 237,980 men, we found that low stress resilience in adolescence was associated with a raised risk of heart disease. A surprising result was that although higher levels of fitness in adolescence were associated with lower heart disease risk, the benefit of such fitness, in terms of heart disease risk, was not present in the men with low stress resilience. (more…)
Author Interviews, Breast Cancer, Duke, Genetic Research, JAMA, Personalized Medicine / 05.03.2015

Dr. Michaela A. Dinan Ph.D Department of Medicine Duke UniversityMedicalResearch.com Interview with: Dr. Michaela A. Dinan Ph.D Department of Medicine Duke University Medical Research: What is the background for this study? What are the main findings? Dr. Dinan: We wanted to examine how  Oncotype DX® Breast Cancer Test (ODX) was being used in real-world practice at the population level. ODX has been examined in clinical trials and limited academic settings but we know that these patients are often younger, have fewer medical comorbidities, and do not necessarily accurately reflect the majority patients with cancer.  In our study, we observed that Oncotype DX® Breast Cancer Test was being used predominately in accordance with guidelines which recommend the test for women with estrogen-receptor positive, disease. We also looked just at women under the age of 70 who met guideline criteria for testing, because this population would include those women who were more likely to be chemotherapy candidates, and we saw a rapid uptake of the test between 2005 and 2009, with use of the test increasing from 8% to 39%. (more…)
AHA Journals, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Nutrition / 05.03.2015

Luc Djousse, MD, ScD, FAHA Associate Professor of Medicine, Harvard Medical School Editor-in-Chief, Current Nutrition Reports Director of Research, Division of Aging Brigham and Women's Hospital Boston, MA 02120MedicalResearch.com Interview with: Luc Djousse, MD, ScD, FAHA Associate Professor of Medicine, Harvard Medical School Editor-in-Chief, Current Nutrition Reports Director of Research, Division of Aging Brigham and Women's Hospital Boston, MA 02120 MedicalResearch: What is the background for this study? What are the main findings? Dr. Djousse: While some studies have reported a higher risk of coronary heart disease, diabetes, or high blood pressure with frequent consumption of fried foods, other investigators did not confirm those results. To date, only few studies have evaluated whether frequent consumption of fried foods can raise the risk of developing heart failure. Frying foods not only increases the energy density of foods, but also increase the amount of trans fats. Trans fats can lead to development of heart disease and diabetes and consumption of energy-dense foods in large quantity can lead to weight gain and resulting cardiovascular consequences. We followed about 15000 US male physicians who were free of heart failure for an average of 10 years and found that frequent consumption of fried foods was related to a higher risk of developing heart failure. For example, people that consumed fried foods daily or more were twice more likely to develop heart failure than individuals who consumed fried foods less than once per week. (more…)
Author Interviews, Endocrinology, JAMA, Thyroid Disease / 05.03.2015

Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma RomaMedicalResearch.com Interview with; Sebastiano Filetti MD Dipartimento di Medicina Interna Università di Roma Roma MedicalResearch: What is the background for this study? What are the main findings? Dr. Filetti: Thyroid nodule diagnosis is becoming more and more frequent in clinical practice. This trend stems largely from the incidental discovery of small nodules due to the increased use of diagnostic imaging for purposes unrelated to the thyroid. Ultrasound studies, for example, are widely used for evaluating other structures in the neck, such as the carotid arteries, parathyroid glands, lymph nodes, and salivary glands. Over 90% of detected thyroid nodules are clinically insignificant, in that they have been cytologically proven to be benign or they have no ultrasound features that raise the suspicion of malignancy. However, consensus is lacking regarding the best way to follow these nodules, mainly because little is known about the actual frequency and magnitude of their growth. The results of our study suggest that most benign nodules exhibit no significant size changes over time, and some actually decrease in size. Only a small subgroup of nodules can be expected to grow, about 15% in our series. However, the growth is slow and limited in magnitude. Most important, the occurrence of cancer is very rare in nodules like this, that appear to be benign. (more…)
AHA Journals, Author Interviews, Heart Disease, Wake Forest / 05.03.2015

Simon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem NC 27157MedicalResearch.com Interview with: Simon A. Mahler MD, MS, FACEP Associate Professor Department of Emergency Medicine Wake Forest School of Medicine Winston-Salem NC 27157 Medical Research: What is the background for this study? Dr. Mahler: Care patterns for patients with acute chest pain are inefficient. Most patients presenting to US Emergency Departments (ED) with chest pain, including those at low-risk for acute coronary syndrome (ACS), are hospitalized for comprehensive cardiac testing. These evaluations cost the US health system $10-13 billion annually, but have a diagnostic yield for ACS of <10%. American College of Cardiology/ American Heart Association (ACC/AHA) guidelines recommend that low-risk patients with acute chest pain should receive serial cardiac markers followed by objective cardiac testing (stress testing or cardiac imaging). However, guideline adherent care among low-risk patients fails to accurately focus health system resources on those likely to benefit. Among low-risk patients, who have acute coronary syndrome rates less than 2%, objective cardiac testing  is associated with a substantial number of false positive and non-diagnostic tests, which often lead to invasive testing. Consensus is building within the US health care system regarding the need to more efficiently evaluate patients with acute chest pain. Medical Research: What are the main findings? Dr. Mahler: Patients randomized to the HEART Pathway were less likely to receive stress testing or angiography within 30 days than patients in the usual care arm (an absolute reduction of 12%. P=0.048). Early discharge (discharges from the ED without stress testing or angiography) occurred in 39.7% of patients in the HEART Pathway arm compared to 18.4%: an absolute increase of 21.3% (p<0.001). Patients in the HEART Pathway group had a median LOS of 9.9 hours compared to 21.9 hours in the usual care group: a median reduction in LOS of 12 hours (p=0.013). These reductions in utilization outcomes were accomplished without missing adverse cardiac events or increasing cardiac-related ED visits or non-index hospitalizations. The HEART Pathway, which combines the HEART score, with 0- and 3-hour cardiac troponin tests, is an accelerated diagnostic protocol (ADP), which may improve the value of chest pain care by identify patients who can safely be discharged from the ED without stress testing or angiography. Observational studies have demonstrated that the HEART Pathway can classify >20% of patients with acute chest pain for early discharge while maintaining a negative predictive value (NPV) for major adverse cardiac event (MACE) rate of greater than 99% at 30 days. However, prior to this study the real-time use of the HEART Pathway had never been compared with usual care. Therefore, we designed a randomized controlled trial to evaluate the efficacy of the HEART Pathway to guide providers’ testing and disposition decisions for patients with acute chest pain. The hypothesis was that the HEART Pathway would meaningfully reduce objective cardiac testing, increase early discharges, and reduce index hospital length of stay compared to usual care while maintaining high sensitivity and NPV (>99%) for MACE. (more…)
Author Interviews, Compliance, Technology / 05.03.2015

MedicalResearch.com Interview with: Avinash Pandey, the study author, is a high school student who conducted this study under the guidance of his mentor, Niteesh K. Choudhry., M.D., Ph.D., executive director of the Center for Healthcare Delivery Sciences, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass. Medical Research: What is the background for this study? What are the main findings? Response: Numerous studies have demonstrated that there is poor adherence to medications in cardiac patients (coronary artery disease patients, CAD). Despite the fact that non-adherence to these medications can have serious consequences on long-term health like disease progression, increased risk of cardiac events and premature mortality, many patients consistently miss their medications and many stop their medications only months after they are prescribed. This non-compliance leads to high costs for the health care system and more potentially preventable cardiac events. Studies suggest, that for the vast majority of patients, non-adherence to medications is not intentional. A significant portion simply forget to take their medications. Although many systems are available today to reduce medication non-adherence, like pill boxes and blisterpacks, these have demonstrated limited effect on medication adherence. Other systems may be expensive to purchase and cumbersome to use or of limited availability. With the proliferation of cellphones, text message reminders could represent a simple, cost-effective method to improve adherence to medications. This research began as a high school science fair project 4 years ago and has evolved into a large ongoing assessment of the impact of mobile technologies on adherence to evidence based therapies and lifestyle interventions in a broad cross-section of cardiovascular patients and those at risk for cardiovascular disease. The current report examines the impact of an automated computer program which sends free, personalized text messages to remind patients to adhere to their medications. 30 CAD patients were recruited from a single centre cardiac practice, in this 2 month cross-over study. Patients were randomized to either receive text message reminders in the first month or the second month. Adherence of each patient was compared between months. Text message reminders were shown to significantly impact medication adherence. Patients missed on average 60% less doses when receiving text message reminders. These numbers were even greater when looking at pre-specified groups identified in previous studies to be at high risk of medication non-adherence, including depression patients, dementia patients, elderly patients, and patients with less than 12 years of education. All patients improved with text message reminders but those with the lowest adherence improved the most. Although this study did not examine clinical outcomes, the text message reminder system appears to be a simple and widely applicable method to improve adherence to medications. The system is free to operate and represents no cost for patients receiving messages. Thus it could be implemented at an individual level or by physicians and clinics to improve patient adherence to medications. (more…)
Author Interviews, Outcomes & Safety, Surgical Research / 05.03.2015

E. Patchen Dellinger, M.D. Professor of Surgery University of Washington, Box 356410 Seattle, Washington MedicalResearch.com Interview with: E. Patchen Dellinger, M.D. Professor of Surgery University of Washington Seattle, Washington Medical Research: What is the background for this study? What are the main findings? Dr. Dellinger: We know from previous large studies that use of checklists is associated with improvements in patient morbidity and mortality. However, recent large studies have also shown that mandating teams to use the checklist without providing the support required for adequate implementation does not result in better outcomes. This report reviews findings from studies examining checklist compliance and use. We found that when compliance with the checklist is poor it is not as effective as when the checklist is carried out as it is intended. Checklist use appears to be a marker for institutional culture of safety, and organizations with a more robust safety culture may be more likely to use the checklist in an effective manner with resulting improvements in patient safety. (more…)
Author Interviews, CDC, HIV, Race/Ethnic Diversity, Sexual Health / 05.03.2015

MedicalResearch.com Interview with: Cyprian Wejnert Center For Disease Control MedicalResearch: What is the background for this study? What are the main findings? Cyprian Wejnert: Men who have sex with men (MSM) remain the risk group most severely affected by HIV in the United States, accounting for approximately two-thirds of new infections each year.  Understanding racial and age disparities among MSM is critical to tailor effective prevention efforts. Our study examined data from CDC’s National HIV Behavioral Surveillance system (NHBS) from 20 U.S. cities. We assessed changes in HIV prevalence, awareness of infection, and risk behavior among MSM, by age and race, from 2008 to 2011, finding that: o   Among black Men who have sex with men, 30 percent were HIV-infected overall, and 1 in 5 black MSM aged 18-24 were infected with HIV. Compared to 14 percent and 4 percent among white MSM. o   In all age groups younger than 40 years, black Men who have sex with men were significantly more likely to be HIV-positive compared to all other racial/ethnic groups. o   Disparities in HIV prevalence between black and white MSM were greatest among the youngest MSM, and increased between 2008 and 2011. o   Black MSM were less likely to be aware of their infection than their white counterparts (54 vs. 86 percent). o   Black Men who have sex with men did not report higher levels of condomless sex overall or condomless sex with partners of discordant or unknown HIV status. (more…)
Author Interviews, CDC, Gender Differences, HIV, Race/Ethnic Diversity / 05.03.2015

MedicalResearch.com Interview with: Dr. Ndidi Nwangwu-Ike Center Disease Control MedicalResearch: What is the background for this study? What are the main findings? Response: CDC data has shown encouraging signs of a decrease in new HIV infections among black women in recent years.  However, African American women continue to be far more affected by HIV than women of any other race or ethnicity, with a rate of new infection 20 times that of white women and nearly five times that of Hispanic women.  Ensuring people with HIV are diagnosed and remain in care is key to controlling HIV in the nation. When used consistently, antiretroviral medication can keep HIV controlled at very low levels in the body (known as viral suppression), allowing people with HIV to live longer, healthier lives and reducing the likelihood they will transmit HIV to others. Our study finds that viral suppression among women diagnosed with HIV is low, with young women and black women the least likely to achieve viral suppression. Specifically, we found that: o   Of women newly diagnosed with HIV in 2012, 83 percent were linked to care within three months of diagnosis. o   Retention in care varied by age and race/ethnicity; overall, just over half of women (52 percent) diagnosed and living with HIV in 2011 received ongoing HIV care. o   Overall, only 44 percent of women diagnosed and living with HIV in 2011 had a suppressed viral load. (more…)
Author Interviews, BMJ / 05.03.2015

Minna Johansson, PhD student Department of Public Health and Community Medicine, Institute of Medicine The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Research Unit and Section for General Practice, Vänersborg, Sweden MedicalResearch.com Interview with: Minna Johansson, PhD student Department of Public Health and Community Medicine, Institute of Medicine The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Research Unit and Section for General Practice, Vänersborg, Sweden Medical Research: What is the background for this study? What are the main findings? Response: The decision to introduce screening for abdominal aortic aneurysms (AAA) was based on four randomised controlled trials from the 1980s and 1990s that showed a 50% relative risk reduction in aneurysm-related mortality. Over the last 15 years Sweden, the UK and the USA have introduced AAA screening programmes. However, abdominal aortic aneurysms screening does not only have intended benefits but also unintended harms. The most important harm is overdiganosis; i.e. the overdetection of aneurysms that would not have caused symptoms in that man´s remaining life, nor been the cause of his death. In this study, we estimate that 176 of every 10,000 men invited to screening are overdiagnosed as a consequence of screening. These men are unnecessarily turned into patients and may experience appreciable anxiety throughout their remaining lives. Moreover, 37 of these men unnecessarily have preventive surgery and 1.6 of them die as a consequence. Furthermore, a recent drop in abdominal aortic aneurysms prevalence by over 70% reduces the potential benefits of AAA screening. Unfortunately, the harms are not likely to be reduced by the same rate, thus leading to a worsened benefit:harm ratio. This means that the benefit:harm ratio is likely to be worse in current screening programmes than in the trials on which they were based. Additionally, it has been proposed to lower the cut-off for the abdominal aortic aneurysms-diagnosis from 30 to 25 mm. Our estimates show that such a change of definition would increase the rate of overdiganosis substantially and further worsen the benefit:harm ratio of abdominal aortic aneurysms screening. (more…)
Author Interviews, HPV, Lancet, Vaccine Studies / 05.03.2015

MedicalResearch.com Interview with: Marc Brisson Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease Associate Professor, Université LavalMedicalResearch.com Interview with: Marc Brisson Canada Research Chair in Mathematical Modeling and Health Economics of Infectious Disease Associate Professor, Université Laval Medical Research: What is the background for this study? What are the main findings? Response: Since 2007, 52 countries have implemented human papillomavirus vaccination (HPV) programmes. Two HPV vaccines are currently available worldwide: the bivalent vaccine, which targets HPV types 16 and 18, causing 70-80% of cervical cancer, and the quadrivalent vaccine, which also targets HPV types 6 and 11, associated with 85-95% of anogenital wart cases. Large international randomised controlled clinical trials have shown both vaccines to be safe, well tolerated and highly efficacious against vaccine-type persistent infections and precancerous cervical lesions.  Furthermore, both vaccines have shown some level of cross-protection against 3 HPV types (HPV 31, 33 and 45) not included in the vaccine and associated with a supplementary 10-15% of cervical cancers worldwide. Now that 7 years have elapsed since the implementation of the first HPV vaccination program, we verified whether the promising results from clinical trials are materialising at the population level. We conducted a meta-analysis to examine the population-level impact in countries that have introduced HPV vaccination programs. In countries with high female vaccination coverage (<50%), our main findings indicate:
  • sharp declines in HPV-related outcomes among females targeted for vaccination (e.g., HPV-16/18 infection and anogenital warts declined by more than 60% in females younger than 20 years), and
  • evidence of cross-protection with significant reductions in HPV-31/33/45 infection among females younger than 20 years
  • evidence of herd effects (indirect benefit of vaccination among unvaccinated individuals) with significant reductions in anogenital warts among males and older females.
In countries with low coverage (<50%), we report:
  • significant reductions in HPV-16/18 infection and anogenital warts among young females, with no indication of herd effects or cross-protection. (more…)
Allergies, Author Interviews, Microbiome, Pediatrics / 04.03.2015

Anita Kozyrskyj Ph.D Professor, Department of Pediatrics University of AlbertaMedicalResearch.com Interview with: Anita Kozyrskyj Ph.D Professor, Department of Pediatrics University of Alberta Medical Research: What is the background for this study? What are the main findings? Prof. Kozyrskyj: Our study determined what "good" gut bacteria were present in 166 full-term infants enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) Study. Funded by CIHR and AllerGen NCE, this landmark study involves more than 3,500 families and their newborn infants across Canada. Gut bacteria were identified by DNA sequences extracted from infant poop. Infants with a fewer number of different bacteria in their gut at 3 months of age were more likely to become sensitized to foods such as milk, egg or peanut, by the time they were 1 years old. Infants who developed food sensitization also had altered levels of two specific types of bacteria, Enterobacteriaceae and Bacteroidaceae, compared to infants who didn’t. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Cleveland Clinic, NEJM / 04.03.2015

Halle C.F. Moore, M.D. Cleveland Clinic Foundation Taussig Cancer Institute Cleveland, OH 44195MedicalResearch.com Interview with: Halle C.F. Moore, M.D. Cleveland Clinic Foundation Taussig Cancer Institute Cleveland, OH 44195 Medical Research: What is the background for this study? What are the main findings? Dr. Moore: Ovarian failure is a common long-term side effect of chemotherapy. Previous studies investigating whether suppressing ovarian function during chemotherapy treatment will preserve ovarian function following chemotherapy have had mixed results. Our study found that suppressing the ovaries with the GnRH analog goserelin during chemotherapy treatment for early stage ER-negative breast cancer resulted in a reduced risk of ovarian failure two years after initiation of treatment. Also, more women who received the goserelin with chemotherapy became pregnant than women who received chemotherapy without goserelin. In addition, there was an apparent improvement in survival among the goserelin group, confirming the safety of this approach in this patient population. (more…)
Author Interviews, Heart Disease / 04.03.2015

MedicalResearch.com Interview with: Joo-Yong Hahn, MD, PhD Associate Professor Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Medical Research: What is the background for this study? What are the main findings? Response: In the Effects of Postconditioning on Myocardial Reperfusion in Patients with ST-segment Elevation Myocardial Infarction (POST) trial, ischemic postconditioning failed to improve myocardial reperfusion (Hahn JY et al. Circulation 2013;128:1889-96) . However, long-term effects of ischemic postconditioning on clinical outcomes are not known in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, the aim of this study was to investigate the long-term effects of ischemic postconditioning on clinical outcomes. In this prospective, randomized trial, ischemic postconditioning with primary percutaneous coronary intervention  (PCI) did not improve clinical outcomes compared with conventional primary PCI in patients with STEMI. There was no significant difference in a composite of death, myocardial infarction, severe heart failure, or stent thrombosis between the 2 groups. Beneficial effects of ischemic postconditioning were not found in any of various subgroups. (more…)
Author Interviews, Breast Cancer, Chemotherapy, Lancet / 04.03.2015

MedicalResearch.com Interview with: Dr. Lucia Del Mastro MD Department of Medical Oncology Istituto Nazionale per la Ricerca sul Cancro Genova, Italy Medical Research: What is the background for this study? What are the main findings? Response: Adjuvant chemotherapy regimens with anthracyclines and taxanes improve the outcome of patients with early breast cancer. Among the most widely used anthracycline-based chemotherapy in sequential combinations with the taxane paclitaxel (P) there are epirubicin and cyclophosphamide (EC) and fluorouracil, epirubicin, and cyclophosphamide (FEC). The contribution of fluorouracil to the anthracycline-cyclophosphamide regimen (EC) was unclear until now. Various randomized trials attempted to assess the role of a more intense schedule of chemotherapy (i.e. dose-dense chemotherapy with cycles administered every 2 weeks instead of every 3 weeks) in patients with early breast cancer. However, most of these trials compared dose-dense chemotherapy with regimens that use standard intervals but with different drugs or dose in the treatment groups, thus making difficult to extrapolate the true role of the dose-dense strategy. The results of GIM2 study show that the addition of fluorouracil to  a sequential regimen with epirubicin, cyclophosphamide and paclitaxel increases the toxicity, in terms of neutropenia, fever, nausea, and vomiting, and is not associated with an improved outcome compared with the same treatment without fluorouracil. (more…)
Author Interviews, Mental Health Research, Pediatrics, University of Pennsylvania / 04.03.2015

Courtney Benjamin Wolk, Ph.D. Postdoctoral Researcher Center for Mental Health Policy and Services Research Perelman School of Medicine Department of Psychiatry University of Pennsylvania Philadelphia, PA 19104MedicalResearch.com Interview with: Courtney Benjamin Wolk, Ph.D. Postdoctoral Researcher Center for Mental Health Policy and Services Research Perelman School of Medicine Department of Psychiatry University of Pennsylvania Philadelphia, PA 19104 Medical Research: What is the background for this study? What are the main findings? Response: Previous research investigating the relationship between anxiety and suicidality has been mixed. An ongoing question in the field has been whether anxiety disorders independently increase risk for suicidal ideation and behavior or if the high co-occurrence of anxiety and mood symptoms or other shared demographic factors are driving relationships that have been observed between anxiety and suicidality. We examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts 7 to 19 years after treatment with cognitive-behavioral therapy, more commonly referred to as CBT. Our results indicated that participants who responded favorably to cognitive-behavioral therapy during childhood had lower rates of lifetime, past month, and past two-week suicidal ideation endorsement than treatment non-responders. This was the case across both self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, though plans and attempts were infrequently endorsed in our sample, limiting the ability to detect findings. (more…)
Author Interviews, Genetic Research, Nature / 04.03.2015

Fernando Pardo-Manuel De Villena, PhD Professor and Associate Chair for Research Department of Genetics School of Medicine University of North Carolina at Chapel HMedicalResearch.com Interview with: Fernando Pardo-Manuel De Villena, PhD Professor and Associate Chair for Research Department of Genetics School of Medicine University of North Carolina at Chapel Hill Medical Research: What is the background for this study? What are the main findings? Response: We set out to identify mutations that affect diseases through changes in gene expression. Our first major finding is that some mouse populations such as the Collabaorative Cross are exceptionally good models to achieve this goal. We also wanted to sort out an ongoing controversy about the number, location and type of genes that are differentially expressed when you inherit them from your mom or your dad (so called imprinted genes).  We conclude that to some extent both sides were right; there are only a limited number of imprinted genes in the classical sense but there are also hundreds or thousands of genes that are preferentially expressed from the father. (more…)
Author Interviews, Cancer Research, MD Anderson, PNAS / 04.03.2015

MedicalResearch.com Interview with: Kristen Turner PhD. (first author) and Wei Zhang, Ph.D. Professor Department of Pathology Director, Cancer Genomics Core Lab University of Texas MD Anderson Cancer Center Houston, Texas 77030 Medical Research: What is the background for this study? What are the main findings? Response: Glioblastoma (GBM) is the most commonly diagnosed type of brain tumor and is among the most aggressive and challenging cancer types to treat. The traditional approaches to combat this pervasive cancer include surgery combined with radiation and chemotherapy (temozolomide); yet, most will succumb to the disease in just over one year. In this study, we investigated the Akt family of proteins that are known to be highly active in the majority of Glioblastoma cases. We compared each Akt family member and its ability to initiate glioma progression. We discovered that activation of the third Akt member (Akt3) led to glioma progression and very aggressive tumors. We then studied these tumors to compare their molecular attributes and found evidence of increased DNA repair. Finally, we discovered that the Akt3-induced DNA repair function led to increased survival of Glioblastoma cells after treatment with the DNA damaging agents, radiation and temozolomide. (more…)