Accidents & Violence, Author Interviews, Mental Health Research, Race/Ethnic Diversity, Social Issues / 26.11.2018

MedicalResearch.com Interview with: "USA - NY - City of New York Police VARIATION" by conner395 is licensed under CC BY 2.0Dr. Jordan E. DeVylder, PhD Graduate School of Social Service Fordham University, New York, New York MedicalResearch.com: What is the background for this study? What are the main findings? Response: This study is intended to address the lack of empirical research on police violence from a public health perspective. The main findings are that police violence is relatively widespread in Baltimore and New York City, is disproportionately directed toward people of color and sexual or gender minorities, and is associated with psychological distress, suicidal behavior, and psychosis-like symptoms. (more…)
Author Interviews, Dermatology, JAMA / 26.11.2018

MedicalResearch.com Interview with: Dr Tarun Narang MD MNAMS Department of Dermatology, Venereology, and Leprology Postgraduate Institute of Medical Education and Research Chandigarh, India MedicalResearch.com: What is the background for this study? Response: Acne is one of the most common dermatological problem for which the patients seek medical care. Post acne scarring is a complication of acne, resulting in long lasting physical disfigurement and low self esteem in the affected individuals. Even though there are various methods like microneedling, chemical peeling, cryorolling and ablative lasers to address the post acne atrophic scarring, these procedures are office based hence physician dependent. A home based treatment modality that can treat post acne atrophic scarring with a comparable efficacy to the procedural modalities of treatment will be beneficial to the patient. Our study was done to assess the efficacy of a topical modality of treatment, tazarotene gel, 0.1% in the management of post acne atrophic scarring in comparison to an established method, the microneedling. (more…)
Author Interviews, Environmental Risks, JAMA, Melanoma / 24.11.2018

MedicalResearch.com Interview with: Reza Ghiasvand, PhD Oslo Centre for Biostatistics and Epidemiology Faculty of Medicne University of Oslo Oslo, Norway  MedicalResearch.com: What is the background for this study? Response: Melanoma is the most dangerous type of skin cancer. It is estimated that about 288,000 individuals will be diagnosed and about 61,000 will die from it in 2018, with the majority of patients in Australia, New Zealand, Europe and North America. Ultraviolet (UV) exposure (from both the sun and tanning beds) is the most important preventable risk factor for melanoma. However, the association between UV exposure and melanoma is complex and does not accord with a simple model in which risk increases directly with exposure. An individual risk of melanoma also depends on personal characteristics such as skin color and skin sensitivity to the UV exposure, hair color, number of moles, and age. It has been hypothesized that the pattern of UV exposure may play a role in melanoma development in different body sites. For example, melanoma on the trunk (chest and back) has been linked to the recreational UV exposure such as sunbathing and frequent sunburns in people with high number of moles on their body. In contrast, melanomas on the head and neck have been linked to constant sun exposure such as occupational UV exposure, mainly in older people. Epidemiologic and molecular evidence in support of this hypothesis has been published based on analyses of small datasets. Also, melanoma on legs and arms is less studied under this hypothesis. In our study, we examined UV exposure (sunbathing, sunburn and sunbed use) and pigmentary factors (skin, eye, and hair color, freckling, and number of moles), and risk of melanoma on different body sites. We used information from the Norwegian Women and Cancer Study, a population-based cohort study that started in 1991, and includes more than 161,000 Norwegian women followed for an average of 18 years. (more…)
Author Interviews, BMJ, Brigham & Women's - Harvard, Diabetes, Occupational Health / 24.11.2018

MedicalResearch.com Interview with: "Night Shift" by Yuchung Chao is licensed under CC BY-ND 3.0Dr. Zhilei Shah PhD Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety Ministry of Education Key Lab of Environment and Health, School of Public Health Tongji Medical College, Huazhon University of Science and Technology Wuhan,  China MedicalResearch.com: What is the background for this study? Response: Shift work has progressed in response to changes in economic pressure and greater consumer demand for 24-hour services. There are many economic advantages to increased shift work, including higher employment, increased services to customers, and improved trade opportunities. Currently, one in five employees in the U.S. works nonstandard hours in the evening, night, or rotating shifts. However, shift work, especially night shift work, has been associated with a higher risk of chronic diseases, including type 2 diabetes, cardiovascular disease, and several types of cancer. Compelling evidence has shown that body weight and lifestyle behaviors, such as smoking, diet, and physical activity can influence type 2 diabetes risk. Among shift workers, excess adiposity and increased smoking are frequently and consistently reported, whereas the evidence on physical activity and diet is mixed. Additionally, no previous study has examined the joint associations of rotating night shift work duration and unhealthy lifestyle factors with risk of type 2 diabetes, or evaluated their potential interactions. Therefore, we prospectively assessed the joint association of rotating night shift work and established type 2 diabetes lifestyle risk factors with risk of type 2 diabetes and quantitatively decomposed the proportions of the joint association to rotating night shift work alone, to lifestyle alone and to their interaction in two large US cohorts. (more…)
Author Interviews, CDC, Exercise - Fitness, JAMA, Lifestyle & Health / 24.11.2018

MedicalResearch.com Interview with: Emily N Ussery, PhD Epidemiologist LT, US Public Health Service Physical Activity and Health Branch National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention  MedicalResearch.com: What is the background for this study? Response: Sitting for too long and being physically inactive can have negative health consequences, and it is important to understand how common these behaviors are among US adults. This study describes sitting time and leisure-time physical activity reported by US adults in a national survey. (more…)
Author Interviews, Hospital Readmissions, JAMA, Schizophrenia, University of Pittsburgh / 22.11.2018

MedicalResearch.com Interview with: Hayley D. Germack PHD, MHS, RN Assistant Professor, School of Nursing University of Pittsburgh MedicalResearch.com: What is the background for this study? What are the main findings? Response: As nurse scientists, we repeatedly witness the impact of having a serious mental illness (i.e. schizophrenia, bipolar disorder, and major depression disorder) on patients’ inpatient and discharge experience. As health services researchers, we know how to make use of large secondary data to illuminate our firsthand observations. In 2016, Dr. Hanrahan and colleagues (https://www.sciencedirect.com/science/article/pii/S0163834316301347) published findings of a secondary data analysis from a large urban hospital system that found 1.5 to 2.4 greater odds of readmission for patients with an  serious mental illness diagnosis compared to those without. We decided to make use of the AHRQ’s HCUP National Readmissions Database to illuminate the magnitude of this relationship using nationally representative data. We found that even after controlling for clinical, demographic, and hospital factors, that patients with SMI have nearly 2 times greater odds of 30-day readmission.  (more…)
Asthma, AstraZeneca, Author Interviews, Pulmonary Disease / 22.11.2018

MedicalResearch.com Interview with: “Asthma Inhaler” by NIAID is licensed under CC BY 2.0Sean O'Quinn MPH Director, Patient Reported Outcomes AstraZeneca  MedicalResearch.com: What is the background for this study? How does benralizumab differ from traditional medications for asthma? Response:  FASENRA™ (benralizumab 30mg for subcutaneous injection as add-on maintenance therapy in severe eosinophilic asthma for patients 12 years and older) has a strong clinical profile, including powerful efficacy against exacerbations and the ability to improve lung function. Benralizumab is a respiratory biologic that binds directly to the IL-5α receptor on eosinophils and attracts natural killer cells to induce rapid and near-complete depletion of eosinophils via apoptosis. (NOTE: The mechanism of action of FASENRA in asthma has not been definitively established.) Benralizumab is not indicated for treatment of other eosinophilic conditions or for relief of acute bronchospasm or status asthmaticus. The most common adverse reactions include headache and pharyngitis. Dependence on rescue medications is indicative of poor asthma control. In the Phase III SIROCCO/CALIMA trials, patients with severe eosinophilic asthma had significantly reduced exacerbation frequency and improved lung function when treated with benralizumab 30mg Q8W (first three doses Q4W) vs. placebo. Less was known about the effects of benralizumab on rescue medication usage—specifically daily total rescue medication use, daytime and nighttime rescue medication use, and nighttime awakenings requiring rescue medication use. The aim of this analysis was to understand the potential treatment effects of benralizumab on these parameters.  (more…)
Author Interviews, JAMA, Weight Research / 22.11.2018

MedicalResearch.com Interview with: Ching-Ti Liu, PhD Department of Biostatistics Boston University School of Public Health Boston, Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Being overweight and obese are increasing worldwide and this obesity epidemic threatens to reverse the gains in life expectancy achieved over the past century. However, many investigators have observed, paradoxically, that overweight individuals are associated with a lower mortality risk. These results may suffer from a potential confounding due to illness or reverse causality in which preexisting conditions may alter both body weight and the risk of death.  Recently published studies have tried to mitigate this reverse causal bias by implementing sample exclusion and they came to a different conclusion: between BMI and all-cause mortality there is an increased risk of death for the entire range of weights that are in the overweight and obesity ranges. However, the elimination strategies may lead to the loss of generalizability or precision due to over-adjustment. In addition, the traditional investigations have only utilized a subject’s weight at a single point in time, which makes it difficult to adequately address bias associated with reverse causality. Currently, the idea incorporating a subject’s weight history has been proposed to deal with the concern of reverse causality, but the existing works had been based on a subject’s recall or self-reported data, which may lead to misclassification and, therefore, result in overestimating the risk of mortality. To help assess the relevance of being overweight or obese to the risk of death in the general population, we conducted a prospective study, using an individuals’ maximum BMI before the beginning of survival follow-up instead of their weight status at a single point in time, using data from the Framingham Heart Study (FHS). We observed increasing risk of mortality across various BMI categories (overweight < obese I < obese II) relative to normal weight using maximum BMI over 24 years of weight history. (more…)
Author Interviews, Cleveland Clinic, Heart Disease, JACC, Surgical Research / 22.11.2018

MedicalResearch.com Interview with: Peter Hu MD Cleveland ClinicPeter T. Hu MD Department of Cardiology Cleveland Clinic MedicalResearch.com: What is the background for this study? What are the main findings? Response: Among patients with blockages in multiple coronary vessels, we studied predictors and outcomes of having a staged versus one-time multivessel percutaneous coronary intervention. By "staged" we mean performing coronary intervention only on one vessel, letting the patient recover, and fixing the other blockages at a later date. We know that multivessel coronary artery disease is very common - present in up to 2/3 of patients who require coronary interventions. Previous studies in patients with STEMI (ST-elevation myocardial infarction) suggested that staged multivessel PCI was associated with lower risk of death compared with one-time multivessel revascularization. Outside of STEMI patients, very little data exist in a broader group of patients who undergo coronary interventions to multiple vessels. In our study, we found an association between doing a staged PCI and lower long-term mortality benefit compared with fixing multiple blockages at once. What was surprising was there seemed to be a correlation with the degree of benefit from staged PCI based on the symptoms and signs the patient presented with. The association with improved outcomes was strongest in patients with STEMI, followed by those with NSTEMI, unstable angina, and stable angina, respectively. We also found that the decision to perform staged PCI was driven by patient and procedural characteristics, as well as other unmeasured site variation.  (more…)
Author Interviews, Gastrointestinal Disease, Microbiome, NEJM, Pediatrics, Probiotics / 22.11.2018

MedicalResearch.com Interview with: Stephen Freedman MDCM, MSc Alberta Children's Hospital Foundation Professor in Child Health and Wellness Sections of Pediatric Emergency Medicine and Gastroenterology Alberta Children's Hospital & Research Institute University of Calgary Calgary, AB  MedicalResearch.com: What is the background for this study? Response: Vomiting and diarrhea remain extremely common diseases in children and are the most common reason children are brought for emergency department care in North America.  While we have options to reduce vomiting there historically has been little physicians can offer to reduce the severity of the diarrhea. Probiotics have recently emerged as an option with some early evidence of benefit in clinical trials but the studies performed to date have been small and few little research has been conducted in North America in outpatient or emergency department children. The one study to date that was performed in a US emergency department did not find probiotic use to be beneficial.  Given the increasing importance of clarifying this issue we undertook this study. (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension / 20.11.2018

MedicalResearch.com Interview with: Adam Bress, Pharm.D Department of Population Health Sciences School of Medicine University of Utah MedicalResearch.com: What is the background for this study? What are the main findings? o   The background here is that the new 2017 ACC/AHA BP guidelines lowered the threshold for antihypertensive medication initiation and intensification from <140 mmHg in most patients to <130 mm Hg. o   We used contemporary, population-based studies of US adults to estimate the potential population health impact of achieving and maintaining the lower treatment targets recommended in the 2017 ACC/AHA BP guidelines compared to previous guidelines. o   We found that achieving and maintain the lower thresholds recommended in the 2017 ACC/AHA BP guidelines over 10 years would:
  • Prevent 3.0 million CVD events compared to currently blood pressure and treatment levels
  • Prevent 0.5 million more events compared to achieving and maintain JNC7 goals
  • Prevent 1.4 million more events compared to achieving and maintain JNC7 goals
o   We estimated the size of the population health impact of achieving and maintaining the lower blood pressure treatment targets in the 2017 ACC/AHA BP guidelines compared to previous guidelines.
  • Achieving and maintaining the lower blood pressure thresholds for antihypertensive medication initiation and titration by the 2017 guidelines, are projected to prevent ~20% and ~90% more CVD events over ten years compared to achieving and maintaining JNC7 or JNC8 goals respectively.
o   Although we estimated more adverse events with the lower treatment goal, what our analysis found is that the benefits of achieving and maintaining the 2017 high blood pressure treatment recommendations far outweighs the risks. Many adverse events from high blood pressure treatment can be managed medically – and the lower threshold for treatment could potentially help millions of Americans lower their chances of developing heart disease or dying from heart attacks, strokes and other cardiovascular events, (more…)
Author Interviews, Heart Disease, JACC, Surgical Research, Technology / 20.11.2018

MedicalResearch.com Interview with: Evolut TAVR PlatformDr. Shazia Afzal MD University Hospital Düsseldorf, Medical Faculty, Division of Cardiology, Pulmonology and Vascular Medicine, Düsseldorf, Germany MedicalResearch.com: What is the background for this study? Response: Since its introduction in 2002, transcatheter aortic valve replacement (TAVR) emerged to an increasingly important interventional procedure in the field of structural heart disease. Widespread use in Europe, the USA and Canada lead to continuous technological development and improved patient’s safety, procedural success and clinical outcome. In 08/2017 one of the market leaders introduced its latest generation valve model -the CoreValve Evolut PROTM- which was especially designed to mitigate paravalvular leakage after valve deployment. We conducted the first prospective study which directly compares the Evolut PROTM with its direct predecessor the Evolut RTM as a head-to-head analysis especially focusing on hemodynamic performance and clinical outcome in a real-world setting. To ensure comparability between groups, we performed propensity score matching with special interest in CT-derived data to guarantee equitable anatomical conditions. Since both valves are on the market but sold at different prices the pivotal question is whether the Evolut PROTM reaches its target. In a highly budget restricted health care system with limited refunding cost-effectiveness evolves to a substantial discussion point in daily clinical practice. Our results may not be marketing friendly but we think of relevance for the interventional community.  (more…)
Author Interviews, CMAJ, HIV, Sexual Health / 20.11.2018

MedicalResearch.com Interview with: Rachel Rodin Centre for Communicable Diseases and Infection Control Public Health Agency of Canada MedicalResearch.com: What is the background for this study? What are the main findings? Response: On December 1, 2016 (World AIDS Day), the Honourable Jody Wilson-Raybould, federal Minister of Justice, committed to working with provinces and territories, affected communities, and medical professionals to examine the criminal justice system’s response to non-disclosure of HIV status in the context of sexual relations. To this end, Justice Canada worked with the Public Health Agency of Canada (PHAC), provincial and territorial public health and justice counterparts, and a variety of other stakeholders to develop a comprehensive report on the issue of HIV non-disclosure. As part of this work, Justice Canada asked PHAC to provide an assessment of the most recent medical science on sexual HIV transmission risk. In collaboration with external peer reviewers, PHAC undertook a systematic review of the full body of scientific evidence on sexual HIV transmission risk. The review found that the risk of sexual transmission of HIV is negligible when an individual is taking antiretroviral therapy as prescribed and maintains a suppressed viral load. The review also concluded that the risk remains low when the individual is on antiretroviral therapy with varying viral load, or is not on antiretroviral therapy but uses condoms.    (more…)
Accidents & Violence, Author Interviews, Pediatrics / 20.11.2018

MedicalResearch.com Interview with: "Pondering a firearm" by Dan Foy is licensed under CC BY 2.0Erin Morgan PhD Student | Department of Epidemiology University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Going into this study we were interested in looking at youth exposure to unsafely stored firearms. Unsafely stored firearms in the household, especially those that are stored unlocked, are a known risk factor for adolescent suicide. We were also interested in looking into a population of children and teens who are at particularly heightened risk for suicide and unintentional injury—those living with an adult who misuses alcohol. Overall, we found that about 30% of those under the age of 18 live in a firearm owning home and among those youth, around 55% lived with a firearm stored in a way other than locked and unloaded. Among those in firearm owning household, we also found that when compared to youth living with a survey respondent that did not report alcohol misuse, those living with an adult that did misuse alcohol were 20% more likely to reside in a home where the firearm was stored unsafely; children were 27% more likely to live in a home reporting unlocked storage, specifically. (more…)
Alcohol, Author Interviews, CDC, JAMA, Primary Care, USPSTF / 20.11.2018

MedicalResearch.com Interview with: Dr. Carol Mangione M.D., M.S.P.H., F.A.C.P Ronald Reagan UCLA Medical Center Division Chief of General Internal Medicine and Health Services Research Professor of Medicine. Barbara A. Levey, MD, and Gerald S. Levey, MD Endowed chair in medicine David Geffen School of Medicine University of California MedicalResearch.com: What is the background for this study? What are the main findings? Response: Unhealthy alcohol use is relatively common and is increasing among U.S. adults. Alcohol use is the third leading cause of preventable death in the U.S. and contributes to more than 88,000 deaths per year. In pregnancy, it also leads to birth defects and developmental problems in children. The Task Force found that screening tests and brief counseling interventions can help detect and reduce unhealthy alcohol use among adults, and in turn help prevent negative consequences related to alcohol use. For adolescents ages 12 to 17, clinicians should use their best judgment when deciding whether or not to screen and refer their patients to counseling, until we have better studies available. (more…)
Author Interviews / 19.11.2018

MedicalResearch.com Interview with: Jace B. King, PhD Department of Radiology and Imaging Sciences Interdepartmental Program in Neuroscience University of Utah, Salt Lake City MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Aberrant brain connectivity is believed to be a robust neurobiological underpinning in individuals with autism spectrum disorder. To date, the majority of functional connectivity fMRI studies have focused on the strength of the relationship between coactivating regions of the brain during a resting state. An often-replicated finding suggests individuals with autism demonstrate increased short-range functional connectivity and decreased long-range functional connectivity. Our study focuses on the temporal domain of functional connectivity fMRI data acquired using long duration multiband, multiecho acquisitions. We used two different measurements of the temporal synchrony between brain regions to establish that, on average, individuals with autism exhibit prolonged functional connectivity in multiple regions associated with a diagnosis of the disorder. A number of these findings were then replicated in a large multisite dataset (Autism Brain Imaging Data Exchange). Additionally, we found a strong positive relationship between the duration of functional connectivity in multiple brain regions and symptoms relating to social dysfunction in individuals with autism suggesting that they may need to hang on to neural connections just a bit longer in order to process social queues and quickly changing novel sensory information. (more…)
Author Interviews, Diabetes, Heart Disease, JAMA, Weight Research / 19.11.2018

MedicalResearch.com Interview with: "Obesity runs rampant in Indiana." by Steve Baker is licensed under CC BY-ND 2.0Haris Riaz MD (Cardiology Fellow Haitham Ahmed MD, MPH , Preventive Cardiologist, Cleveland Clinic, Ohio MedicalResearch.com: What is the background for this study? What are the main findings? Response: Elevated cholesterol (specially low density lipoprotein) has been causally linked to the development of coronary artery disease whereas the causal relationship between obesity and cardiovascular disease has remained controversial. This is important because of increasing epidemic of obesity and metabolic syndrome. Mendelian randomization studies provide one way of determining a causal association where we can look at the outcomes of individuals stratified by the presence or absence of a particular allele. Since these alleles are randomly distributed in the population of interest, this is "nature's randomized trial" in that the particular allele is naturally distributed and hence minimal risk of bias. In other words, lets say that I hypothesize that a particular gene "A" is linked with coronary artery disease. If the given gene is indeed causally linked with coronary artery disease, patients with activation of that gene should have significantly greater risk of developing coronary artery disease. Based on these principles, we conducted a systematic review and meta-analysis of the available evidence and found that the risk of developing coronary artery disease and diabetes is significantly increased with obesity. Although hypothesis generating, we think that these findings may suggest a causal association between obesity and cardiovascular disease.  (more…)
Alzheimer's - Dementia, Author Interviews, JAMA / 19.11.2018

MedicalResearch.com Interview with: "A neonate with Down's?" by Sadasiv Swain is licensed under CC BY 2.0Rosalyn Hithersay LonDowns Kings College, London  MedicalResearch.com: What is the background for this study? What are the main findings? Response: In our research group, we have been following a large group of adults with Down syndrome in the UK to track changes with ageing in their health and cognitive function. It has been known for some time now that people with Down syndrome are at high risk for developing dementia due to Alzheimer’s disease. This new study has shown the huge impact that this risk has on mortality for these adults. We found that dementia is now the likely underlying cause of death in more than 70% of adults with Down syndrome aged over 35 years. This is a much bigger proportion of deaths due to Alzheimer’s disease compared to the general population: in England and Wales only 17.5% of deaths past the age of 65 would be related to dementia of any kind.  (more…)
Author Interviews, Environmental Risks / 19.11.2018

MedicalResearch.com Interview with: Dr. Gilbert Rochon, III PH.D., MPH Adjunct Professor, Dept. of Global Health Management & Policy Tulane University’s School of Public Health & Tropical Medicine Senior Consultant with MSF Global Solutions, LLC New Orleans MedicalResearch.com: What is the background for this study? Response: Having observed the frequency with which President Donald Trump characterized changes in regulatory policies and funding levels with respect to public health and the environment as eliminating or curtailing "unnecesssary Obama-era regulations," I became curious as to the full extent and impact of such deregulation and under-funding of health and environmental safeguards. In the process, I found it necessary to review federal government contributions to public health and the environment under all previous presidents.  (more…)
Author Interviews, JAMA, Ophthalmology, Pediatrics / 19.11.2018

MedicalResearch.com Interview with: "i have a lazy eye but it's a good thing" by jessica mullen is licensed under CC BY 2.0Eileen E. Birch, PhD Director, Crystal Charity Ball Pediatric Vision Evaluation Center Retina Foundation of the Southwest Adjunct Professor of Ophthalmology UT Southwestern Medical Center   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We previously reported that amblyopia, but not nonamblyopic strabismus or anisometropia, is associated with slower reading speed (Kelly et al  Journal of AAPOS 2015) and that this is related to abnormal eye movements and unstable fixation associated with amblyopia (Kelly et al 2017).  We have also shown that amblyopic children are slower at completing Scantron answer sheets (JAMA Ophthalmology 2018).  We thought that these difficulties experiences in school-age children with amblyopia might affect their self-perception. (more…)
Author Interviews, OBGYNE, Omega-3 Fatty Acids / 18.11.2018

MedicalResearch.com Interview with: “omega 3” by Khaldaa Photographer is licensed under CC BY 2.0Philippa Middelton MPH Associate Professor Healthy Mothers, Babies and Children South Australian Health and Medical Research Institute Adelaide, Australia  MedicalResearch.com: What is the background for this study? What are the main findings? Response: For several decades, it has been known that fish or fish oils can lengthen gestation. In our Cochrane review of 70 studies and nearly 20,000 women we show that fish oil (mainly as omega-3 fatty acid supplements), prevents premature birth, specifically
  • An 11% reduction in premature birth < 37 weeks gestation;
  • And a 42% reduction in premature birth < 34 weeks gestation.
(more…)
Author Interviews, Gastrointestinal Disease, Gluten, Microbiome, Nature / 17.11.2018

MedicalResearch.com Interview with: Professor Oluf Pedersen Novo Nordisk Foundation Center for Basic Metabolic Research University of Copenhagen MedicalResearch.com: What is the background for this study? Response: We focused our study on healthy people due to the world-wide bottom-up movement among healthy adults to live gluten-free or on a low-gluten diet. Therefore, we undertook a randomised, controlled, cross-over trial involving 60 middle-aged healthy Danish adults with two eight week interventions comparing a low-gluten diet (2 g gluten per day) and a high-gluten diet (18 g gluten per day), separated by a washout period of at least six weeks with habitual diet (12 g gluten per day). The two diets were balanced in number of calories and nutrients including the same total amount of dietary fibres. However, the composition of fibres differed markedly between the two diets. When the low-gluten trend started years back the trend was without any scientific evidence for health benefits. Now we bring pieces of evidence that a low-gluten diet in healthy people may be related to improved intestinal wellbeing due to changes in the intestinal microbiota which to our surprise is NOT induced by gluten itself but by the concomitant change in the type of dietary fibres linked to a low-gluten intake. (more…)
Author Interviews, Cost of Health Care, JAMA, University of Michigan / 17.11.2018

MedicalResearch.com Interview with: Renuka Tipirneni, MD, MSc Assistant Professor Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024 University of Michigan Department of Internal Medicine, Divisions of General Medicine and Hospital Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI 48109Renuka Tipirneni, MD, MSc Assistant Professor Holder of the Grace H. Elta MD Department of Internal Medicine Early Career Endowment Award 2019-2024 University of Michigan Department of Internal Medicine Divisions of General Medicine and Hospital Medicine, and Institute for Healthcare Policy & Innovation Ann Arbor, MI 48109 MedicalResearch.com: What is the background for this study? What are the main findings? Response:  Navigating health insurance and health care choices is challenging and requires significant health insurance literacy (knowledge and application of health insurance concepts). We looked at the association between U.S. adults' health insurance literacy and avoidance of health care services due to perceived cost. We found that 30% of people we surveyed reported delayed or foregone care because of perceived cost, and that those with lower health insurance literacy reported significantly greater avoidance of both preventive and nonpreventive health care services. (more…)
Author Interviews, Global Health, Heart Disease, JAMA, Pediatrics, Surgical Research / 17.11.2018

MedicalResearch.com Interview with: Marcelo G. Cardarelli, MD Inova Children’s Hospita Fairfax, Falls Church, Virginia MedicalResearch.com: What is the background for this study? What are the main findings? Response: Global Humanitarian Medical efforts consume a large amount of resources (nearly $38B in 2016) and donors (Countries, International organizations, WHO, Individuals) make the decisions as to where their funds should be allocated based on cost-effectiveness studies. Most resources go to prevent/treat infectious diseases, sanitation efforts and maternal/child care issues. An insignificant amount of resources is directed to satisfy the surgical needs of the populations in low and middle income countries (LMICs). The idea behind our project was to find out if it was cost-effective to perform a tertiary surgical specialty (pediatric cardiac surgery) in this context and the answer (at $171 per DALY averted) was an overwhelming yes! But most importantly, we believe, as many others do, that judging the cost/effectiveness of an intervention in order to decide resources allocation is valid for diseases that can be prevented, but not relevant when it comes to surgical problems that are not preventable. Instead, we propose the use of another measure of effectiveness, what we call "The Humanitarian Footprint". The Humanitarian Footprint represents the long term benefits, as measured by changes in the life expectancy, extra years of schooling and potential lifetime earnings of patients treated surgically during humanitarian interventions. To our surprise and based on the results, the effects on society of at least this particular surgical intervention were greater than we expected. We suspect this measure can be used in many other surgical humanitarian interventions as well.  (more…)
Allergies, Author Interviews, Dermatology, Immunotherapy, JAMA / 17.11.2018

MedicalResearch.com Interview with: Christopher S. Lee, PhD, RN, FAHA, FAAN, FHFSA Professor and Associate Dean for Research Boston College William F. Connell School of Nursing Chestnut Hill, MA 02467 MedicalResearch.com: What is the background for this study? Response: Although the efficacy of omalizumab (i.e. can it work?) in the treatment of chronic idiopathic (spontaneous) urticaria has been established in clinical trials, the effectiveness of omalziumab (i.e. does it work?) in the real-world management is less well established. The purpose of this study was to synthesize what is known about the benefits and harms of omalizumab as used in real-world treatment of Chronic Idiopathic (Spontaneous) Urticaria. (more…)
Author Interviews, Heart Disease, JACC, Outcomes & Safety / 17.11.2018

MedicalResearch.com Interview with: Teryl K. Nuckols, MD Vice Chair, Clinical Research Director, Division of General Internal Medicine Cedars Sinai Los Angeles, California MedicalResearch.com: What is the background for this study? Response: The Medicare Hospital Readmissions Reduction Program (HRRP) penalizes hospitals with increased 30-day readmission rates among seniors admitted with heart failure (HF).  Heart failure readmission rates declined markedly following the implementation of this policy. Two facts have raised concerns about whether the HRRP might have also inadvertently increased 30-day heart failure mortality rates. First, before the policy was implemented, hospitals with higher heart failure readmission rates had lower 30-day HF mortality rates, suggesting that readmissions are often necessary and beneficial in this population. Second, 30-day HF mortality rose nationally after the HRRP was implemented, and the timing of the increase has suggested a possible link to the policy. Are hospitals turning patients away, putting them at risk of death, or is the increase in heart failure mortality just a coincidence? To answer this question, we compared trends in 30-day HF mortality rates between penalized hospitals and non-penalized hospitals because 30-day HF readmissions declined much more at hospitals subject to penalties under this policy. (more…)
Allergies, Author Interviews, Pediatrics / 16.11.2018

MedicalResearch.com Interview with: Eliane Abou-Jaoude, MD  Allergy and Immunology Fellow Henry Ford Health System Detroit, MichiganEliane Abou-Jaoude, MD  Allergy and Immunology Fellow Henry Ford Health System Detroit, Michigan MedicalResearch.com: What is the background for this study? Response: Early life exposure to diverse types of microbes is necessary for healthy immune development and may impact the risk for developing allergic disorders. Theoretically the transfer of parental microbes to their offspring during infancy can influence a child’s developing gut microbiome and subsequent immune response patterns. We wished to investigate whether parental pacifier cleaning methods, reported at 6-months of age, were associated with altered serum IgE trajectory over the first 18 months of life.  (more…)
Author Interviews / 16.11.2018

MedicalResearch.com Interview with: "Mothers and Daughters" by Joe Shlabotnik is licensed under CC BY 2.0Robert F. Lynch, PhD Department of Biology University of Turku Turku, Finland  MedicalResearch.com: What is the background for this study? What are the main findings?  Response:  The take home message is that we were trying to experimentally induce something called a Trivers-Willard effect in humans. The Trivers-Willard hypothesis is a theory that uses evolutionary logic to predicts that parents who are in good condition will bias investment towards sons, while parents who are in poor condition will bias investment towards daughters.  The logic is that this should be the case because high-quality sons are expected to out-reproduce high quality daughters, while low-quality daughters are expected to out-reproduce low quality sons. We found almost nothing supporting this.  Instead we found strong and consistent effects across 4 dependent variables (explicitly stated preferences, implicit associations via IAT tests, actual donations to charities after an experimental prime and a forced choice adoption preference) of women preferring daughters or girls and men having either a slight or no preference for sons or boys. Of course we get into the details of why this may not be so surprising after all from an evolutionary point of view.  And we also discuss how things like sexual genetic conflict might mask TW effects and how cultural changes regarding the expected value of males and females may also play a role in explaining these differences.    (more…)
Author Interviews, Gastrointestinal Disease, Microbiome, Pediatrics / 16.11.2018

MedicalResearch.com Interview with: Thomas Thymann PhD DVM MSc Department of Veterinary and Animal Sciences Comparative Pediatrics and Nutrition Faculty of Health and Medical Sciences University of Copenhagen Frederiksberg, Denmark MedicalResearch.com: What is the background for this study? What are the main findings? Response: Infants that are born preterm are at risk of developing a severe and life threatening intestinal disease referred to as necrotizing enterocolitis (NEC). This condition is known to be under influence of several factors including the microorganisms that start to colonize the intestine immediately after birth. We wanted to see whether fecal matter collected from healthy 10-day old piglets, would benefit the pattern of early colonization, and prevent NEC. (more…)