MedicalResearch.com Interview with: Alon Eisen, MD Cardiology Department Rabin Medical Center Petah Tikva Israel Research Fellow in Medicine Brigham and Women's Hospital MedicalResearch: What is the...
MedicalResearch.com Interview with: Dr. Simonetta Genovesi MD
Department of Health Science
University of Milano-Bicocca, Monza
Italy Nephrology Unit
San Gerardo Hospital, Monza, Italy
MedicalResearch: What is the background for this study?
Dr. Genovesi: The prevalence of atrial fibrillation (AF) in patients
with end-stage renal disease (ESRD) on hemodialysis (HD)
is high. The presence of atrial fibrillation increases the risk of
thrombo-embolic stroke in the general population. The
treatment of choice for reducing thrombo-embolic risk in
AF patients is oral anticoagulant therapy (OAT) with
warfarin. However, the use of warfarin in HD patients is
controversial because of the high risk of bleeding and the
fact that it is not demonstrated a clear protection
against the risk of stroke in this population. The purpose
of the study was to prospectively evaluate the effect of
OAT on the risk of mortality, stroke and bleeding in HD
population.
MedicalResearch: What are the main findings?
Dr. Genovesi: In our hemodialysis population oral anticoagulant therapy does not increase the risk of total mortality, while antiplatelet agents are associated
with an increased risk of death of about 70%. The
continuous use of warfarin tends to be associated with
improved survival as compared with individuals who
discontinued the medication during the follow-up, but the
incidence of thrombo-embolic events is not different in
OAT subjects as compared with those who do not take it.
Moreover, bleeding events are more frequent in patients
taking warfarin, although the maintenance over time of an
INR in the therapeutic range wards against the risk of
bleeding.
(more…)
MedicalResearch.com Interview with:
Shannon M. Dunlay, M.D. M.S.
Advanced Heart Failure and Cardiac Transplantation
Assistant Professor of Medicine and Health Care Policy and Research
Mayo Clinic Rochester
MedicalResearch: What is the background for this study?
Dr. Dunlay: Loss of mobility and independence can complicate the care of patients with chronic conditions such as heart failure, and can degrade their quality of life. However, we have a very poor understanding of the burden of disability in patients with heart failure and how it impacts outcomes. What are the main findings? In this study, patients with heart failure were asked whether they had difficulty performing activities of daily living (ADLs)—these include normal activities that most people do in daily life such as eating, bathing, dressing, and walking. Most patients with heart failure reported having difficulty with at least one ADL at the beginning of the study, and over 1/3 had moderate or severe difficulty with activities of daily living. Patients who were older, female and had other chronic conditions such as diabetes, dementia and obesity had more difficulty with activities of daily living. Patients that reported more difficulty with ADLs (worse mobility) were more likely to die and be hospitalized over time. Some patients had a decline in function over time, and this was also predictive of worse outcomes.
(more…)
MedicalResearch.com Interview with:
William Mair, Ph.D Assistant Professor
Department of Genetics and Complex Diseases
Harvard T. H Chan School of Public Health
Boston, MA 02115
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Mair: Dietary restriction, the reduction of food intake without malnutrition has been known for 80 years to prolong lifespan in organisms ranging from single celled yeast to non human primates, and early signs suggest improvement of metabolic parameters in patients undergoing clinical trials. However, negative side effects associated with low calorie intake remain, and compliance and lifestyle factors make it an unappealing therapeutic. Since calorie restriction (CR) can have remarkable protective effects against multiple age onset diseases in mouse models - ranging from cancer to neurodegeneration to metabolic disease - finding molecular mechanisms though which calorie restriction functions might provide novel therapeutic targets that promote healthy aging. Using a model system, the nematode worm C. elegans, we show that perception of energy intake in the nervous system may be as critical for the effects of low energy on aging as actual calorie intake itself. Animals expressing an active form of a protein called AMPK, which is a cellular energy sensor, were long lived despite eating normally but this longevity could be turned off or on by changes to a neurotransmitter in just a few neurons. This suggests that therapeutic targets that modulate the perception of energy status in the nervous system might provide novel ways to gain the benefit of calorie restriction and promote healthy aging.
(more…)Dr. Liming Liang PhD Assistant Professor of Statistical Genetics Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, Massachusetts Allergies affect...
MedicalResearch.com Interview with:
Shyamasundaran Kottilil MBBS, PhD
Division of Infectious Diseases, Institute of Human Virology, University of Maryland, Baltimore
Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
Medical Research: What is the background for this study? What are the main findings?
Dr. Kottilil: Due to shared routes of transmission, almost half of all HIV-infected patients also have HCV infection. Traditionally, interferon based therapies have resulted in lower cure rates of HCV in HIV-infected subjects. Treatment for HCV is rapidly changing from an injection (interferon) based therapy to oral well tolerated pill based therapy for a shorter duration.Our intention was to test whether a treatment regimen without the use of interferon and ribavirin can be effective in HIV/HCV infected patients.
Our study demonstrated that HIV/HCV connected patients without cirrhosis can be effectively treated with ledipasvir and sofosbuvir in 12 weeks. Overall 98% of patients were cured.
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MedicalResearch.com Interview with:
Nisha Bansal MD MAS Assistant Professor
Associate Program Director for Research
Kidney Research Institute Division of Nephrology
University of Washington
Medical Research: What is the background for this study? What are the main findings?
Dr. Bansal: We pursued this study to develop a prediction equation for death among elderly patients with chronic kidney disease (CKD), a high-risk patient population that is often difficult to manage given competing risks of end stage renal disease (ESRD) vs. death. In this paper, we developed and validated a simple prediction equation using variables that are readily available to all clinicians.
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MedicalResearch.com Interview with:
Professor Daniela Jakubowicz MD
Diabetes Unit. E. Wolfson Medical Center
Sackler Faculty of Medicine,
Tel Aviv University and Tel Aviv Medical Center
Israel
MedicalResearch: What is the background for this study? What are the main findings?
Professor Jakubowicz: Obesity epidemic have lead to alarming rise of type 2 diabetes. It is estimated that more than 382 million worldwide have diabetes, predominately type 2 diabetes.
In these persons the cardiovascular disease is the leading complication, carrying 10 to 20-fold increase in the risk compared with persons without diabetes.
It has been shown that large glucose peaks after meals along the day, are strongly associated with increased a risk for cardiovascular complications.
Therefore the mitigation of glucose excursions after meals becomes a major target in the treatment of type 2 diabetes in order to improve glucose balance and prevent complications.
Accordingly, dietary modification focused on reduction post meal glucose peaks is needed. Even though still there is no consensus on which of the dietary strategies (i.e. low-fat diet, Mediterranean and low-carbohydrate, higher fiber, low GI glycemic index meals, etc.) is more suitable in improving post-meal glycemic responses along the day.
However in none of these interventions has been considered that modifying the meal timing pattern or daily caloric distribution, may lead to improved post-meal glycemic responses in type 2 diabetic patients.
The circadian clock genes existing in the pancreatic β-cells, gut, liver and in skeletal muscle, regulate the diurnal (circadian) oscillation of post-meal glucose responses. In fact, post-meal glycemia displays a clear diurnal variation: it is higher and more prolonged in the evening than in the morning. Meal timing schedule, on the other hand, exerts strong controlling influence on circadian clock regulation, thereby influencing the variation and degree of the post meal glycemic elevations. Indeed meal timing non-aligned with the clock gene circadian rhythms, such as breakfast skipping or high-energy intake at dinner, is associated with obesity, higher HbA1C and poor glycaemic control in type 2 diabetes.
To clarify the impact of meal timing and composition on overall post-meal glucose responses, we tested the effect of 2 isocaloric diets with different meal timing one with high energy breakfast (704 kcal), mid-sized lunch (600 kcal) and reduced dinner (200 kcal) and other with similar lunch but reduced breakfast (704 kcal) and high energy dinner(704 kcal).
The study clearly demonstrated that in type 2 diabetic patients, a diet consisting on high energy breakfast, and reduced dinner, resulted in significantly reduced glucose response after meals and lower overall plasma glucose levels along the entire day, when compared to a diet with the same caloric content but inverse distribution: breakfast (200 kcal) , lunch (600 kcal) and high energy dinner(704 kcal).
Moreover, when we compared the glucose response after high energy meal consumed at breakfast (700 kcal) versus in the dinner (700 kcal), it comes out that the glucose response was significantly higher after dinner than after breakfast. It shows that just by changing the time of the high energy meal we may achieve significant reduction in the glucose response.
(more…)MedicalResearch.com Interview with: Gwen Borlaug, CIC, MPH Coordinator, HAI Prevention Program Wisconsin Division of Public Health Madison, WI 53702 MedicalResearch: What is the background for...
MedicalResearch.com Interview with:
Dave Kennaway, PhD Professor
Lloyd Cox Senior Research Fellow,
Head Circadian Physiology Laboratory
School of Paediatrics and Reproductive Health
Robinson Research Institute,
Faculty of Health Sciences, Medical School,
University of Adelaide Australia
MedicalResearch: What is the background for this review? What are the main findings?
Dr. Kennaway: There is evidence that melatonin is being prescribed to for sleep disorders in children and adolescents who are developing normally despite the fact that there have been no properly designed studies on the effects of prolonged administration to children. In countries where melatonin has been registered, it is for use as a monotherapy for the short term treatment of primary insomnia, characterised by poor quality of sleep in patients who are aged 55 years and over. Use in Paediatrics is always “off-label”. After more than 50 years of melatonin research in animals there is overwhelming evidence that melatonin administration affects many organ systems. These include important effects on the reproductive organs of rodents, cats, ruminants and primates and melatonin is in fact registered as a veterinary drug for this purpose. The effects of melatonin, however, go beyond the potential reproductive consequences, including effects on cardiovascular, immune and metabolic systems. It is clear that many paediatricians, practitioners and parents are unaware of this.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Kennaway: Clinicians and patients need to recognise that melatonin is a hormone and not a drug developed for a specific purpose or illness. There have been no appropriate trials in children addressing the effects of prolonged administration of melatonin in children. Given the extensive literature on the role of the hormone in normal physiology it is unlikely that such trials would ever be approved. Should endocrine or other abnormalities appear in the future in children previously treated with melatonin it will not be tenable to argue that we were surprised.
(more…)MedicalResearch.com Interview With Jacek Skarbinski, MD Medical officer Centers for Disease Control and Prevention MedicalResearch: What is the background for this study? What are...
MedicalResearch.com Interview with:
Elmar A. Joura, M.D
Gynecologist
University of Vienna
MedicalResearch: What are the main findings of this study?
Dr. Joura: This study demonstrates that the new ninevalent HPV vaccine induces a good immunogenicity against HPV 6/11/16/18 and gives a 97% protection against disease caused by HPV 31/33/45/52/58. This has a potential of a 90% reduction of cervical cancer and other HPV related cancers and a similar protection against genital warts. The full benefit is seen in persons without current HPV infection, this reinforces early vaccination against HPV. The safety profile was favourable.
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MedicalResearch.com Interview with:
Dr. Masae Kawamura MD
Senior Director, QuantiFERON Medical and Scientific Affairs QIAGEN
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Kawamura: The report in The Lancet presents the baseline phase of China’s first large-scale, multi-center prospective study of the epidemiology of latent tuberculosis infection. The comparison study of more than 21,000 patients allowed detailed analysis of demographics and risk factors, along with robust comparisons within subgroups. The study’s follow-up phase is now underway, and patients with Latent Tuberculosis Infection (LTBI) will be evaluated for rates of disease and associated risks. Generally, up to 10% of people with Latent Tuberculosis Infection will develop active, contagious Tuberculosis (TB) disease at some point.
The overall TB infection rate was 18.8% measured by QuantiFERON-TB Gold compared to 28% by the traditional tuberculin skin test (TST), a difference of over 125 million people (based on 2014 population estimates from China). Unlike the tuberculin skin test, positive rates of QuantiFERON-TB Gold were not related to prior Bacille Calmette-Guérin (BCG) vaccination, but correlated with background active TB and suspect rates, as well as known risks for TB. BCG vaccination is recommended to newborns by the World Health Organization (WHO) as a matter of TB control policy in many countries, including China. (more…)MedicalResearch.com Interview with: Anne-Marie Schjerning Olsen, MD, PhD Department of Cardiology Gentofte Hospital, University of Copenhagen Denmark MedicalResearch.com: What is the background for this study? Dr....
MedicalResearch.com Interview with:
Kari Johansson, PhD
Department of Medicine Solna, Karolinska Institutet
Clinical Epidemiology
Karolinska University Hospital
Stockholm, Sweden
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Johannson: The number of women who are obese in early pregnancy has increased dramatically over the last decades. Consequently, there has been a dramatic rise in the number of women becoming pregnant after bariatric surgery. In Sweden the number of births of women with a history of bariatric surgery has increased from 150 (≈0.15%) to more than 500 (0.5%) per year between 2006 and 2011. The positive effects of bariatric surgery on health outcomes, such as diabetes and cardiovascular disease, are reasonably well-studied, but less is known about the effects on pregnancy and perinatal outcomes. We therefore conducted a population-based study, using data from nationwide Swedish registers.
The main findings are that women who had a history of bariatric surgery were much less likely to develop gestational diabetes (2% compared to 7%; P<0.001) and give birth to large-for-gestational age babies (9% vs 22%; P<0.001). On the other hand, the operated women were twice as likely to give birth to babies who were small for gestational age (16% vs 8%), and have pregnancies of shorter duration (273 vs 277.5; P<0.001).
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MedicalResearch.com Interview with:
Seema Jain, MD
Medical Epidemiologist
Epidemiology and Prevention Branch, Influenza Division
Centers for Disease Control and Prevention
Atlanta, GA 30329
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Jain: Pneumonia is the leading cause of hospitalization among children in the United States with medical costs estimated at almost $1 billion in 2009. The Centers for Disease Control and Prevention’s Etiology of Pneumonia in the Community (EPIC) study was a multi-center, active population-based surveillance study that aimed to estimate the incidence and etiology of community-acquired pneumonia requiring hospitalization in U.S. children. Children in the study were enrolled from January 2010 to June 2012 in three U.S. children’s hospitals in Memphis, Nashville, and Salt Lake City. Study staff tested children using a range of laboratory tests for viral and bacterial respiratory pathogen detection.
During the study period, the EPIC study team enrolled 2,638 children, of which 2,358 (89 percent) had radiographically-confirmed pneumonia. The median age of children in the study was 2 years old. Intensive care was required for 497 (21 percent) of the children, and three children died. Among 2,222 children with radiographic pneumonia and specimens available for both bacterial and viral testing, a pathogen was detected in 1802 (81%). One or more viruses were detected in 1,472 (66%) of these children. Bacteria were detected in 175 (8%), and bacterial and viral co-detection occurred in 155 (7%). The study estimated that annual pneumonia incidence was 15.7/10,000 children during the study period. The highest incidence was among children younger than 2 years old (62.2/10,000). Respiratory syncytial virus (RSV) was the most common pathogen detected (28%), and it was associated with the highest incidence among children younger than 2 years old with pneumonia. Human rhinovirus was detected in 22 percent of cases, but it was also identified in 17 percent of asymptomatic controls who were enrolled, by convenience sample, at the same site during the same time period; thus, making it challenging to interpret the meaning of human rhinovirus detection in children hospitalized with pneumonia. Other detected pathogens were human metapneumovirus (13%), adenovirus (11%), Mycoplasma pneumoniae (8%), parainfluenza viruses (7%), influenza (7%), coronaviruses (5%), Streptococcus pneumoniae (4%), Staphylococcus aureus (1%), and Streptococcus pyogenes (<1%). The low prevalence of bacterial detections likely reflects both the effectiveness of bacterial conjugate vaccines and suboptimal sensitivity of bacterial diagnostic tests. (more…)
MedicalResearch.com Interview with:
Dr. Kristy Barnes Le MD
Department of Internal Medicine
Wake Forest School of Medicine
Winston-Salem, NC
Medical Research: What is the background for this study? What are the main findings?
Response: Because about 1 in 6 Americans binge drink, it is important that physicians know how to screen for at-risk drinking and be able to effectively address alcohol use with their patients. Alcohol screening and brief intervention (SBI) has been shown to be an effective tool to detect and reduce hazardous alcohol use, but it has not yet gained wide acceptance in practice or in medical education. We know that lack of confidence contributes to practicing physicians’ hesitancy to screen and intervene with at-risk drinkers, but this had not been studied in resident physicians.
We set out to determine how primary care resident physicians screen and intervene with their patients who drink, how they feel about discussing at-risk drinking, and what barriers they have to performing Alcohol screening and brief intervention.
Our main findings are:
1.) Resident physicians are using the wrong screening instruments at the wrong times, and are not adequately performing the brief intervention when they do detect hazardous drinking.
Less than 20% of residents in this study used screening instruments that are capable of detecting at-risk or binge drinking, while the remainder used instruments designed to detect alcohol use disorders. And, only 17% screened for at-risk drinking at acute-care visits, where the consequences of binge drinking (such as injuries) are most likely to appear. Additionally, when a brief intervention was performed, only a quarter of residents usually or always included the three recommended elements of feedback, advice, and goal-setting.
2.) Resident physicians do not feel confident addressing at-risk drinking with their patients.
Only 21% felt they could help their patient with hazardous drinking cut down or stop using alcohol and only 17% felt they had been successful in doing so in the past. Interestingly, U.S.-born residents and those reporting no religious affiliation were even more likely to express lack of confidence.
3.) Lastly, residents report barriers that include lack of adequate training (53 %), the belief that talking with patients is unlikely to make a difference (44 %), and just being too busy (39%). The hours of reported Alcohol screening training did not vary with residency year, perhaps indicating that most of it was done prior to residency.
Clearly, the several hours they report getting (mean of 9.8 hours) is either not covering the right topics, or not teaching them in a way that leads to changes in practice. (more…)
MedicalResearch.com Interview with:
Rana Suzette Bonds, MD
The University of Texas Medical Branch
MedicalResearch: What is the background for this study?
Dr. Bonds: Both anaphylaxis and asthma can be life threatening disorders requiring prompt treatment. Each disorder can be successfully treated with medication which is delivered by devices designed for self-administration. Unfortunately there has been evidence in the literature that patients frequently do not use the devices appropriately. We sought to determine which factors were associated with incorrect use of metered dose inhalers and epinephrine autoinjectors, and to determine if rates of correct use have improved since earlier reports.
MedicalResearch: What are the main findings?
Dr. Bonds: Sixteen percent of patients used the epinephrine autoinjector properly and 7 percent of patients used the metered dose inhaler correctly. The most common error with the autoinjector was not holding the unit in place for at least 10 seconds after triggering. For patients using the metered dose inhaler the most commonly missed step was exhaling to functional residual capacity or residual volume prior to actuating the canister. Male sex, Caucasian race, and previous medical education correlated with correct use of epinephrine autoinjector device.
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MedicalResearch.com Interview with:
Eric Crouch, MD, FAAO, FAAP, FACS
Vice Chair, PEDIGAssociate Professor
Department of Ophthalmology
Eastern Virginia Medical School Assistant Professor
Department of Pediatrics Eastern Virginia Medical School
Chief of Ophthalmology, Children's Hospital of the King's Daughters Norfolk, Virginia
MedicalResearch: What is the background for this study?
Dr. Crouch: In this letter PEDIG is reporting on the improvement in vision during the run-in phase of a study in children 3 years of age to less than 8 years old. During the run-in phase, the children were followed at 6 weeks intervals and served as the baseline for entering into a randomized trial for increasing the amount of patching. The patients were randomized to either 2 hours of prescribed patching or 6 hours of prescribed patching once they completed the run-in phase.
MedicalResearch: What are the main findings?
Dr. Crouch: For amblyopic children, even those who have moderate or severe amblyopia in the 20/100 - 20/400 range, clinicians can start treatment with patching two hours a day.
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MedicalResearch.com Interview with:
Dawn Pedrotty, MD, PhD
Cardiovascular Medicine Fellowship
University of Pennsylvania
MedicalResearch: What is the background for this review? What are the main findings?
Dr. Pedrotty: Heart failure (HF) is the most common cause for hospitalization among patients 65 years and older, affecting approximately 6 million Americans; at 40 years of age, American males and females have a one in five lifetime risk of developing heart failure. There are two distinct heart failure phenotypes: a syndrome with normal or near-normal left ventricular ejection fraction (LVEF) referred to as HF with preserved ejection fraction (HFpEF), and the phenotype associated with poor cardiac contractility or heart failure with reduced ejection fraction (HFrEF). Risk factors associated with HFpEF include female gender, especially women with diabetes, higher body mass index, smoking, hypertension, concentric left ventricular hypertrophy (LVH), and atrial fibrillation (AF). There has been a growing interest in the development of criteria for specific subsets of HFpEF, a syndromal disease where multiple cardiac and vascular abnormalities exist. One approach is to implement phenomapping, identifying phenotypically distinct HFpEF categories and developing a classification system to group together pathophysiologically similar individuals who may respond in a more homogeneous, predictable way to intervention. Another option would be to focus on a known physiologic differences which might shed light on pathologic mechanisms e.g. gender and the influences of obesity and atrial fibrillation.
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MedicalResearch.com Interview with:
Gregory YH Lip MD, FRCP (London, Edinburgh, Glasgow), DFM, FACC, FESC
Professor of Cardiovascular Medicine,
Adjunct Professor of Cardiovascular Sciences,
Thrombosis Research Unit, Aalborg University, Denmark;
Aston Centre for Cardiovascular Sciences City Hospital Birmingham
England UK
Medical Research: What is the background for this study? What are the main findings?
Prof. Lip: Women with atrial fibrillation are at higher risk of stroke than men with atrial fibrillation.
The reasons for this elevated risk remain unclear.
The results from our worldwide study suggest that women are treated no differently to men in terms of anticoagulant therapy for stroke prevention.
Thromboprophylaxis was, however, suboptimal in substantial proportions of men and women, with underuse in those at moderate-to-high risk of stroke and overuse in those at low risk.
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MedicalResearch.com Interview with:
Brian Elbel, PhD, MPH
Associate Professor, Department of Population Health;
Associate Professor, Department of Medicine
Population Health NYU School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Elbel: This study tried to determine whether a new supermarket that received tax and zoning credits from New York City, locating in a high need area, impacted healthy eating for children. No previous controlled study has looked at children, and supermarkets are tool being increasingly used to improve healthy eating. We did not find, at least one year after the store opened, any appreciable change in shopping or eating.
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MedicalResearch.com Interview with:
Steven B. Cohen, Ph.D.
Director, Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality
Rockville, Maryland 20850
MedicalResearch: What is the background for this study?
Dr. Cohen: Health care expenditures represent more than one-sixth of the U.S. gross domestic product, exhibit a rate of growth that exceeds other sectors of the economy, and constitute one of the largest components of the federal budget and states’ budgets. Although the rate of growth in health care spending has slowed in the past few years, costs continue to rise. As a result, an evaluation of the current health care system requires an understanding of the patterns and trends in the use of health care services and their associated costs and sources of payment. Studies that examine the concentration and persistence of high levels of expenditures over time are essential to help discern the factors most likely to drive health care spending and the characteristics of the individuals who incur them.
MedicalResearch: What are the main findings?
Dr. Cohen: Using information from the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) sponsored by the Agency for Healthcare Research and Quality (AHRQ), this study provides detailed estimates of the concentration and persistence in the level of health care expenditures in the United States. Attention is given to identifying the characteristics of individuals with the highest levels of medical expenditures, in addition to those factors that are associated with low medical expense profiles.
In 2011, 1 percent of the population accounted for 21.5 percent of total health care expenditures, and in 2012, the top 1 percent accounted for 22.7 percent of total expenditures with an annual mean expenditure of $97,956. The lower 50 percent of the population ranked by their expenditures accounted for only 2.8 percent and 2.7 percent of the total for 2011 and 2012 respectively. Of those individuals ranked at the top 1 percent of the health care expenditure distribution in 2011 (with a mean expenditure of $92,825), 19.6 percent maintained this ranking with respect to their 2012 health care expenditures.
In both 2011 and 2012, the top 10 percent of the population accounted for 65.3 percent of overall health care expenditures in 2011 (with a mean expenditure of $27,927), and 41.5 percent of this subgroup retained this top decile ranking with respect to their 2012 health care expenditures. Those who were in the top decile of spenders in both 2011 and 2012 differed by age, race/ethnicity, sex, health status, and insurance coverage (for those under 65) from those who were in the lower half in both years. (more…)
MedicalResearch.com Interview with:
Judith Lichtman, PhD, MPH
Associate Professor (with tenure)
Chair, Department of Chronic Disease Epidemiology
Yale School of Public Health
New Haven, CT 06520-803
Medical Research: What is the background for this study? What are the main findings?
Dr. Lichtman: Heart disease in younger women (18-55 years of age) is relatively rare, and represents less than 5% of all heart disease in women; however, young women who present with a heart attack are twice as likely to die in the hospital as compared with a similarly aged man, and this excess mortality risk continues beyond the index event. Delays in seeking prompt care has been suggested as one potential cause for the excess mortality in young women. We were interested in learning about the recognition of symptoms, perceived risk of heart disease, decision-making process to seek medical care, and interactions with the healthcare system among young women who recently had a heart attack. We found that even though the majority of young women presented with chest pain, they also experienced many other symptoms such as fatigue, nausea, muscle pain, and weakness. They commonly attributed symptoms to non-cardiac conditions because they felt they did not experience the “Hollywood Heart Attack” that is commonly portrayed in the media. Interestingly, despite reporting a strong family history of cardiac disease, and having multiple risk factors, many of the women we spoke with did not perceive they were at risk for heart disease, and many were not working with their physicians to manage their risk factors. They were also concerned about being seen as a hypochondriac if they reported their symptoms. Finally, women reported that the healthcare system was not consistently responsive when they reported their symptoms.
(more…)MedicalResearch.com Interview with: Dr Søren Dalsgaard National Centre for Register-based Research Aarhus University Denmark Medical Research: What is the background for this study? What...
MedicalResearch.com Interview with:
Jacob (Yaqub) Hanna M.D. Ph.D.
Kimmel Investigator | NYSCF Robertson Investigator
The Department of Molecular Genetics
Weizmann Institute of Science, Israel
MedicalResearch: Could this be helpful for any individual with infertility problems?
Dr Hanna: Our research is focused on taking skin cell samples and converting them into embryonic-like stem cells (iPS cells) via direct reprogramming and without using embryo derived stem cell lines. Then we are focusing in differentiating these male or female iPS lines into sperm cells or oocytes, respectively. We have succeeded in the first and most important step of the process, where we succeed in reaching the progenitor cell state for sperm and egg (we have not achieved mature sperm and eggs ….Very important to emphasize!). So we are now focusing on completing the second half of this process. Once that is achieved this may become useful for any individual with fertility problems.
MedicalResearch: Could this be a viable option ALSO for same-sex couples? What are the prospects for letting gay or lesbian couples produce progenitor cell state cells from their skin cells? For example, is it conceivable that the "second half" of the protocol could some day also be done in vitro (making fully mature sperm and eggs), so that men could produce egg cells and women sperm cells?
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MedicalResearch.com Interview with:
Fernanda C. Lessa, M.D., M.P.H.
Centers for Disease Control and Prevention
Atlanta, GA
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Lessa: The epidemiology of Clostridium difficile has gone through dramatic changes over the last decade. C. difficile has become the most common cause of healthcare-associated infections in US hospitals and it has been also increasingly reported outside of healthcare settings. As the epidemiology of this pathogen changes, it is important to understand the magnitude and scope of this infection in the United States to help guide priorities for prevention.
Main findings:
1) C. difficile was responsible for almost half million infections and associated with 29,000 deaths in 2011 in the United States
2) Among the patients who developed C. difficile, 83,000 had recurrent infections
3) C. difficile incidence was higher among females, whites, and persons 65 years of age or older
4) Approximately 345,400 infections occurred outside of the hospital indicating that C. difficile prevention should go beyond hospital settings.
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MedicalResearch.com Interview with:
Professor Stephen Peckham
Director, Centre for Health Services Studies
Professor of Health Policy
Department of Health Services Research and Policy
London School of Hygiene and Tropical Medicine
Director, Policy Research Unit in Commissioning and the Healthcare System University of Kent
Medical Research: What is the background for this study? What are the main findings?
Response: Community water fluoridation remains a controversial public health measure. There have been continued debates about both its effectiveness in the prevention of dental caries and also its safety. Previous studies have suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism few population level studies have been undertaken. In April 2014 Public Health England published a monitoring report that used secondary analysis of routine health statistics to identify whether water fluoridation in England was associated with any adverse health outcomes. While hypothyroidism data is available this was not included in their monitoring report. In England approximately 10% of the population lives in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. Tt examine whether there is a relationship – as suggested in smaller studies – we used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/13 Quality Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner (GP) registered patient numbers, and 2012 practice level Index of Multiple Deprivation scores. We found a positive association between fluoride levels and hypothyroidism. High hypothyroidism prevalence was found to be at least 30% more likely in practices located in areas with fluoride levels in excess of 0.3mg/L. This population study supports earlier hypotheses that fluoride is associated with hypothyroidism. In the UK water is fluoridated at 1ppm (1mg/L) and in areas where water is fluoridated the model predicts that after controlling for other factors, practice populations are significantly more likely to have higher levels of hypothyroidism than those in non-fluoridated areas. Higher levels of fluoride in drinking water, therefore, provide a useful contribution for predicting prevalence of hypothyroidism. For example in contrasting two urban areas we found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).
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