Author: Marie Benz MD FAAD
30 Aug Alzheimer Disease: Homozygous Genetic Loci Identified
MedicalResearch.com Interview with:
Ekaterina Rogaeva, PhD
Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, Canada
Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, Ontario, CanadaDepartment of Medicine, University of Toronto, Toronto, Ontario, CanadaCambridge Institute for Medical Research and Department of Clinical Neurosciences, University of Cambridge, Cambridge, England
MedicalResearch.com: What are the main findings of the study?
Answer: We tested the hypothesis that late-onset Alzheimer disease (AD) might be in part explained by the homozygosity of unknown loci. In a genome-wide study of a Caribbean Hispanic population with noticeable inbreeding and high risk of AD we assessed the presence of long runs of homozygosity (ROHs) – regions where the alleles inherited from both parents are identical. Our results suggest the existence of recessive AD loci, since the mean length of the ROH per person was significantly longer in AD cases versus controls, and this association was stronger in familial AD.
30 Aug Breast Cancer Risk: Increased by Pre- First Pregnancy Alcohol Intake
MedicalResearch.com Interview with: Ying Liu, MD, PhD Instructor, Division of Public Health Sciences Department of Surgery Washington University School of Medicine 660 South Euclid Ave Campus Box 8100 St. Louis, MO 63110 MedicalResearch.com: What are the main findings of the study? Answer: Alcohol intake between menarche (first menstrual period) and first pregnancy was consistently associated with increased risks of breast cancer and proliferative benign breast disease. For every 10 gram/day alcohol intake (approximately a drink a day) during this specific time period, the risk for breast cancer increased by 11% and the risk for proliferative benign breast disease increased by 16%.30 Aug Depression: Association with Low Physical Activity, Prolonged Sitting
MedicalResearch.com Interview with:
Jannique van Uffelen, PhD, MSc (epidemiology),
MSc (human movement sciences), BHealth
Senior Research Fellow Active Ageing
INSTITUTE OF SPORT, EXERCISE & ACTIVE LIVING (ISEAL)
VICTORIA UNIVERSITY
MedicalResearch.com: What are the main findings of the study?
Answer: We examined the link between sitting-time and physical activity with current and future depressive symptoms in 8,950 mid aged women, who participated in the Australian Longitudinal Study on Women’s Health.
Both high sitting-time and low physical activity levels were associated with higher risk of current depressive symptoms, and in combination, the risk further increased. Compared with women sitting ≤4 hours/day and meeting the physical activity recommendations of at least 150 minutes of moderate intensity activity per week, women who sat >7 hrs/day and who did no physical activity were three times as likely to have depressive symptoms. However, only lack of physical activity was associated with increased risk of future depressive symptoms, irrespective of sitting-time. Women who did no physical activity were 26% more likely to have future depressive symptoms than women meeting physical activity recommendations.
29 Aug Rheumatoid Arthritis: Are Two Drugs Better than One?
MedicalResearch.com Interview with:
Dr. Janet E Pope
Division of Rheumatology, Department of Medicine
The University of Western Ontario, St Joseph's Health Centre
268 Grosvenor Street, London, ON, Canada N6A 4V2
MedicalResearch.com: What are the main findings of the study?
Dr. Pope: We performed a RCT of patients who were stable for 6 months of etanercept added to methotrexate (inadequate responders to Mtx) who were randomized to stopping Mtx or continuing Mtx to determine if in the next 6 months (and later as the trial continues) the response rate would be the same if Mtx was discontinued. Overall, Mtx + etanercept was not statistically equivalent to etanercept alone (ie non-inferiority did not occur); implying 6 months after stopping Mtx, the etanercept patients on monotherapy performed slightly less well than those on combination therapy.
29 Aug Pregnancy: Birth Defects Risks with Oral Fluconazole
MedicalResearch.com Interview with: Ms. Mølgaard-Nielsen Statens Serum Institut Artillerivej 5, 2300 Copenhagen S, Denmark MedicalResearch.com: What are the main findings of the study? Answer: Use of oral fluconazole during early pregnancy did not increase the risk of birth defects overall in common therapeutic doses. We also looked at 15 individual birth defects of previous concern and oral fluconazole was not associated with an increased risk for 14 of these birth defects. However, we did see an increase in the risk of tetralogy of Fallot, an uncommon congenital heart defect, but the number of exposed cases was few.29 Aug Kaiser’s Hypertension Program Dramatically Improves Blood Pressure Control in Large Population
Posted at 11:27h
in Author Interviews, Blood Pressure - Hypertension, Health Care Systems, JAMA, UCSF
MedicalResearch.com Interview with:
Dr. Marc Jaffe, MD
Clinical Leader, Kaiser Northern California Cardiovascular Risk Reduction Program
Clinical Leader, Kaiser National Integrated Cardiovascular Health (ICVH) Guideline Development Group
Associate Clinical Professor of Medicine, UCSF
Endocrinology and Internal Medicine
Kaiser South San Francisco Medical Center
1200 El Camino Real
South San Francisco, California 94080
MedicalResearch.com: What are the main findings of the study?
Dr. Jaffe: In 2001, we set out to improve blood pressure control in among Kaiser Permanente (KP) members in Northern California, and we ended up creating one of the largest, community-based hypertension programs in the nation. The paper published in JAMA explores how we combined a number of innovations, including a patient registry, single-pill combination therapy drugs and more, to nearly double blood pressure control rates.
If you had told us at the onset that blood pressure control among members would be more than 80 percent, and it was actually almost 90 percent in 2011, we wouldn’t have believed you. These results are truly incredible. During the study period, hypertension control increased by more than 35 percent from 43.6 percent to 80.4 percent in Kaiser Permanente Northern California between 2001 and 2009. In contrast, the national mean control rate increased from 55.4 percent to 64.1 percent during that period.
29 Aug Cancer Patients: Coping, Medication Adherence if under Financial Distress
MedicalResearch.com Interview with:
S. Yousuf Zafar, MD, MHS
Assistant Professor of Medicine
Duke Cancer Institute
twitter: @yzafar
MedicalResearch.com: What are the main findings of the study?
Dr. Zafar: We found that cost-related medication non-adherence was prevalent among cancer patients who sought financial assistance. Nearly half of participating cancer patients were non-adherent to medications as a result of cost. Patients used different cost-coping strategies, for example, trying to find less expensive medications, borrowing money to pay for medications, and otherwise reducing spending. We found that non adherent participants were more likely to be young, unemployed, and without a prescription medication insurance plan.
28 Aug Observation Status: Effect of “Two Midnights” Rule on LOS, Skilled Nursing Placement
MedicalResearch.com Interview with: Ann M. Sheehy, M.D., M.S. Associate Professor Division Head, Hospital Medicine University of Wisconsin Department of Medicine MedicalResearch.com: What are the main findings of the study? Answer: The Centers for Medicare and Medicaid Services (CMS) has changed their definition for observation status. Previously, observation status was determined by Interqual clinical criteria. The new...
28 Aug Diabetes with CAD: Genetic Link Related to Glutamic Acid Metabolism
MedicalResearch.com Interview with:
Lu Qi, MD, PhD, FAHA
Assistant Professor of Medicine
Harvard Medical School
Assistant Professor of Nutrition
Harvard School of Public Health
MedicalResearch.com: What are the main findings of the study?
Answer: The main findings include, we for the first time identified a genetic variant predisposing to high risk of coronary heart disease in patients with type 2 diabetes, using genome-wide association (GWA) approach. More interesting, we demonstrated that the variant may affect expression of a gene involved in metabolism of amino acid glutamic acid, which has been related to insulin secretion and heart health in previous studies.
28 Aug Obesity: Inflammatory Markers May Detect Risk of Diabetes, Heart Disease
MedialResearch.com Interview with: Dr Catherine M. Phillips Health Research Board Centre for Diet and Health Research Room 4.033, Department of Epidemiology and Public Health Western Gateway Building, University College Cork, Cork, Ireland MedialResearch.com: What are the main findings of the study? Answer: Obesity is associated with increased risk of diabetes and heart disease leading to reduced life expectancy. However in recent years it has been recognized that not all obese individuals are at increased risk – these individuals have been described as being metabolically healthy obese (MHO) in that despite carrying excess weight they do not have the typical abnormal metabolic features associated with obesity such as hypertension, insulin resistance and alterations to their lipid profile. It is not clear what factors determine whether an obese person becomes metabolically healthy or unhealthy. In this study conducted at the Dept. of Epidemiology and Public Health at University College Cork, Ireland, we examined levels of a range of inflammatory markers in 2047 middle-aged Irish adults to investigate to what extent differences between metabolically healthy and unhealthy obese and non-obese male and female adults are explained by inflammatory status. Participants, who were between the ages of 50 and 69, completed lifestyle questionnaires, physical and clinical assessments, and underwent blood testing so their body mass index (BMI), metabolic profiles and inflammatory markers could be determined. We found that, regardless of a person’s BMI, having a favorable inflammatory profile was associated with being metabolically healthy. Specifically metabolically healthy individuals presented with lower levels of complement component 3, C reactive protein, tumour necrosis factor alpha, interleukin 6, plasminogen activator inhibitor-1, reduced white blood cell count and higher adiponectin levels compared to their metabolically unhealthy counterparts.28 Aug Prostate Cancer: Coffee and Tea Association
MedicalResearch.com Interview with:
Janet L. Stanford, MPH, PhD
Full Member, Research Professor
Co-Head, Program in Prostate Cancer Research
Fred Hutchinson Cancer Research Center
1100 Fairview Ave. N. M4-B874
Seattle, WA 98109-1024
MedicalResearch.com: What are the main findings of the study?
Dr. Stanford: The main finding from our research is that one or more cups of coffee per day is associated with a 56% to 59% reduction in the risk of prostate cancer recurrence or progression in men diagnosed with this common disease. In our cohort of prostate cancer patients, 61% reported drinking at least one cup of coffee per day, with 14% reporting drinking 4 or more cups per day. The lower risk for prostate cancer recurrence/progression observed in coffee drinkers, however, was seen even for those who consumed only one cup per day, suggesting that even modest intake of coffee may offer health benefits for prostate cancer patients.
27 Aug Leaving Hospital Against Medical Advice Raises Readmission, Death Risk
MedicalResearch.com Interview with:
Allan Garland, MD, MA
Co-Head, Section of Critical Care Medicine
Associate Professor of Medicine and Community Health Sciences
University of Maniitoba
820 Sherbrook St / GF-222
Winnipeg, Manitoba R3A 1R9
MedicalResearch.com: What are the main findings of the study?
Answer: Our study evaluated consequences of leaving the hospital against medical advice (AMA). It is a large, population-based analysis, that evaluated all hospitalizations from which patients were discharged alive, among all adults in the Canadian province of Manitoba over a 19 year period; this was over 1.9 million hospitalizations. Outcomes assessed were hospital readmission and death over 6 months after the event. Specifically, we compared these outcomes for those who left the hospital against medical advice, compared to those who remained in the hospital until their doctors felt it was safe to be discharged -- and these comparisons adjusted for a variety of patient and illness characteristics.
Among the 1.9 million hospitalizations, there were 21,417 that ended with the patients leaving against medical advice, this is 1.1% of the total. Without adjustment for other variables, leaving against medical advice was associated with double the rate of unscheduled hospital readmission within 30 days (24.0 vs. 12.1%); after adjustment, the odds of unscheduled hospital readmission within 30 days was 3-fold higher for someone who left against medical advice compared to one who did not. After adjustment, the odds of death at 90 days were 2.51-fold higher for those who left against medical advice.
27 Aug Depression and Systolic Blood Pressure Variability
MedicalResearch.com Interview with: Marcos A Sanchez-Gonzalez, M.D., Ph.D., EPC Postdoctoral Associate Department of Biomedical Sciences College of Medicine The Florida State University 1115 W Call Street BMS 2300-24 & The Family Institute Behavioral Cardiology Laboratory Longmire 301 Tallahassee, FL 32306 MedicalResearch.com: What are the main findings of the study? Answer: The findings of our study were the following: (1) The low frequency component of systolic blood pressure variability (LFSBP; a marker of sympathovagal tone) was a stronger predictor of depressive symptoms than conventional measures of cardiovascular functioning such as laboratory measurement of blood pressure and heart rate variability as well as home based ambulatory blood pressure monitoring (2) Depressive symptoms were associated with a blunted LFSBP response to sympathetic stimulation via cold pressor test; and (3) Participants with acute depression (a score of ≥16 using the CES-D scale) had higher LFSBP than those with normal depressive symptom scores. These findings suggest that depressive symptoms evoke alterations in vascular sympathetic activity, and more importantly, this alteration is occurs early in the progression of the disease. This is fascinating owing to the fact that we have documented a common pathway of disease between depression and cardiovascular diseases.27 Aug Lupus Nephritis Susceptibility Genes Identified
Hemodialysis.com Interview with: Dr. David W. Powell PhD Associate Director of Clinical Proteomics Assistant Professor of Medicine Assistant Professor of Biochemistry and Molecular Biology Department of Medicine/Nephrology 570 South Preston Street Baxter Research Building I, Room 102 South Louisville, Kentucky Hemodialysis.com: What are the main findings of the study? Dr. Powell: We found a strong association for variants...
27 Aug Depression: Effectiveness of Collaborative Care
MedicalResearch.com Interview with: David A Richards, PhD Professor of Mental Health Services Research and NIHR Senior Investigator University of Exeter Medical School Sir Henry Wellcome Building University of Exeter Washington Singer Building The Queen’s Drive Exeter EX4 4QQ United Kingdom MedicalResearch.com: What are the main findings of the study? Answer: We found that collaborative care improves depression immediately after treatment compared to usual care, has effects that persist to 12 month follow-up and is preferred bypatients over usual care. This difference in effect equated to a standardized effect size of 0.26 (95% CI 0.07 to 0.46). More participants receiving collaborative care than those receiving usual care met criteria for recovery (odds ratio 1.67 (95% confidence interval 1.22 to 2.29); number needed to treat=8.4) and response (1.77 (1.22 to 2.58); 7.8 at 4 months. At 12 months follow up more participants in collaborative care than those in usual care met criteria for recovery (odds ratio 1.88 (95% confidence interval 1.28 to 2.75); number needed to treat=6.5) and response (1.73 (1.22 to 2.44); 7.3. Collaborative care is as effective in the UK healthcare system—an example of an integrated health system with a well developed primary care sector—as in the US.27 Aug Vertebral Fractures: Inflammation, hsCRP association in Men
MedicalResearch.com Interview with: Anna Eriksson MD, PhD Centre for Bone and Arthritis Research Institute of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden MedicalResearch.com: What are the main findings of the study? Answer: The main findings of the study are that low-grade inflammation as measured by high sensitive CRP (hsCRP) is a risk factor for fractures in men, and that this is mainly driven by an increased risk for vertebral fractures. Previous epidemiological research has shown that higher levels of hsCRP is associated with an increased risk for fractures in women but until now it has not been known whether this applies also to men. The associations between hsCRP and fracture risk remained also after controlling for a wide range of known risk factors for fractures. There were no associations between hsCRP and BMD in our study. This implies that low-grade inflammation is an independent risk factor for fractures.26 Aug Pediatric Magnet Ingestions Continue to Rise
MedicalResearch.com Interview with:
Dr. Jonathan Silverman, MD
Department of Pediatrics
University of Washington in Seattle, Washington
MedicalResearch.com: What are the main findings of the study?
Dr. Silverman: We looked at the incidence of magnet foreign body injuries in children between 2002-2011, using a Consumer Products Safety Division surveillance database. We found an estimated 22, 581 cases over that period. Most strikingly, we found a rise in the incidence of magnet ingestions (in cases per 100,000 children/yr) from 0.57 (95% CI 0.22-0.92) in 2002-2003 to 3.06 (95% CI 2.16-3.96) in 2010-2011. The mean age for ingested magnets was 5, but for nasal magnets was 10. Multiple magnet ingestions and magnet injuries requiring hospital admission were much more common in the second half of the study period, corresponding with the rising popularity of small, high-powered, desktop magnet sets. However, due to limited detail from the database, we were unable to say with any certainty whether injuries were specifically due to these magnet sets.
26 Aug Stroke: Ultra-Early Thrombolysis Therapy
MedicalResearch.com Interview with: Daniel Strbian, MD, PhD, MSc (Stroke Med), FESO Associate Professor Department of Neurology Helsinki University Central Hospital PL 340, 00290 HUS MedicalResearch.com: What are the main findings of the study? Dr. Strbian: That providing early treatment is not enough, we have to be ultra-early.26 Aug CRT-D: Cardiac Resynchronization plus Defibrillator – Predicting Who Does Best
MedicalResearch.com Interview with:
Dr Pamela N Peterson MD
Denver Health Medical Center, CO
MedicalResearch.com: What are the main findings of the study?
Answer: We assessed the outcomes of mortality, rehospitalization, and procedural complications among 24,169 patients in the NCDR-ICD Registry with left ventricular systolic dysfunction receiving a cardiac resynchronization device in addition to an implantable defibrillator for the primary prevention of sudden cardiac death between 2006 and 2009. After stratification by the QRS complex morphology and duration on the ECG and adjustment for measured differences in other characteristics, patients with left bundle branch block (LBBB) and QRS durations of at least 150 msec had significantly lower rates of mortality and rehospitalization at 3 years compared with patients with non-LBBB QRS morphology and/or QRS duration of 120-149 msec. Rates of mortality and readmission were generally highest in patients with non-LBBB and QRS duration of 120-149 msec. Rates of procedural complications at 30- and 90-days were similar across strata of QRS morphology and duration.
26 Aug Overactive Bladder: Use of Antimuscarinics
MedicalResearch.com Interview with: Kirill Kosilov Far Eastern Federal University Department of Neurourology-Urodynamics, Primorsky Regional Diagnostic Center, Vladivostok, Russian Federation MedicalResearch.com What are the main findings of the study? Answer: Our study in a group of elderly patients showed that the combination of antimuscarinic drugs in a dosage which is higher than the usual recommended one is an effective treatment option for patients with OAB in those cases where treatment with one antimuscarinic drug was poorly effective. Side effects occurred almost equally in patients treated with only one antimuscarinic drug compared to the combined dosage.24 Aug Diabetes: Exercise Improves Glycemic Control if Pancreatic Beta-Cell Function Remains
MedicalResearch.com Interview with:
Thomas P. J. Solomon, Ph.D.
Associate Professor of Biomedical Sciences
Department of Biomedical Sciences | Cellular & Metabolic Research Section
Panum Institute 4.5 | University of Copenhagen | Blegdamsvej 3B | 2200 Copenhagen N | Denmark
MedicalResearch.com: What are the main findings of the study?
Dr. Solomon: The main findings were that when impaired glucose tolerant and type 2 diabetic subjects underwent 3-4 months of regular aerobic exercise training, although the majority of subjects (86-90%) increased increased VO2max, lost weight, and increased insulin sensitivity, only around two-thirds of subjects improved glycemic control (HbA1c, fasting glucose, and 2-hour OGTT glucose). The novel finding was that the changes in glycemic control were congruent with changes in oral glucose-stimulated insulin secretion (GSIS). We also found that exercise training-induced changes in glycemic control were related to changes in GSIS (P0.05), but not insulin sensitivity. Furthermore, we found that training-induced improvements in glycemic control were largest in subjects with greater pre-training GSIS, i.e. in subjects with greatest beta-cell function. And, we noted that high pre-training hyperglycemia blunted exercise-induced improvements in beta-cell compensation for insulin resistance.
23 Aug Breast Cancer Screening: Risk of False-Positive Results
MedicalResearch.com Interview with:
Solveig Hofvind, PhD
Cancer Registry of Norway, Oslo and Akershus University College of Applied Sciences, Majorstua 0403, Oslo, Norway
MedicalResearch.com: What are the main findings of the study?
Dr. Hofvind: We find that if 100 women aged 50 years attend the Norwegian Breast Cancer Screening Program as recommended, every two years until they are 69 years, four women will undergo a needle biopsy with benign outcome (a false positive needle biopsy).
In the same group of women, twenty women will be recalled for further examination and have additional imaging, ultrasound, and/or a biopsy with negative outcome (a false positive screening result).
23 Aug Breast Cancer: Surgical Oophoretomy + Tamoxifen – Impact on Bone Loss
MedicalResearch.com: Interview with:
Richard R. Love, MD MS
International Breast Cancer Research Foundation
Professor of Medicine and Public Health The Ohio State University
Columbus, OH
MedicalResearch.com: What are the main findings of the study?
Answer: Surgical oophorectomy and tamoxifen treatment was associated with no loss of bone mineral density (BMD) in the femoral neck, and loss of BMD in the first year, followed by stabilization in the lumbar spine.
23 Aug Stretch Marks: Four Genetic Markers Near Elastin Gene Identified
MedicalResearch.com Interview with:
Joyce Y Tung Ph.D.
Research Team
23andMe Inc.
Mountain View, California, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Tung: 23andMe researchers identified four genetic markers that were significantly associated with the development of stretch marks, including one near the elastin (ELN) gene. This finding may further explain why some individuals are more susceptible to the skin condition. Given that loose skin is a symptom of syndromes caused by deletion or loss-of-function mutations in ELN, these results also support the hypothesis that variations in the elastic fiber component of the skin extracellular matrix contribute to the development of stretch marks.
23 Aug Delirium Prediction Rule: the AWOL Tool
MedicalResearch.com Interview with:
Vanja Douglas, MD
Sara & Evan Williams Foundation
Endowed Neurohospitalist Chair
Assistant Professor of Clinical Neurology
UCSF Department of Neurology
Neurology Clerkship Director
Editor in Chief, The Neurohospitalist
MedicalResearch.com: What are the main findings of the study?
Answer: The study found that a simple 2-minute assessment performed at the time of hospital admission can accurately predict an adult medical inpatient's risk of developing delirium during that hospitalization.
23 Aug Electronic Health Record Utilization as a Measure of Hospital Care Intensity
MedicalResearch.com Interview with:
Saul Blecker, MD, MHS
Assistant Professor
Department of Population Health
NYU School of Medicine
227 East 30th St., #648
New York, NY 10016
MedicalResearch.com: What are the main findings of the study?
Dr. Blecker: We tracked utilization of the inpatient electronic health record (EHR) as a proxy for hospital intensity of care. EHR utilization was found to have variations over time, particularly when comparing days to nights and weekdays to weekends.