Blog – Medical Research News and Interviews
11 Feb Euthanasia and/or Physician Assisted Suicide in Psychiatric Disorders Legal in Belgium and The Netherlands
MedicalResearch.com Interview with: [caption id="attachment_21492" align="alignleft" width="160"]
Dr. Scott Kim[/caption]
Scott Y. H. Kim, MD, PhD
Department of Bioethics, National Institutes of Health
Bethesda, MD 20892
Medical Research: What is the background for this study?
Dr. Kim: Euthanasia and/or physician assisted suicide (EAS) of persons suffering from psychiatric disorders is increasingly practiced in some jurisdictions such as Belgium and the Netherlands but very little is known about the practice. There is an active debate over whether to legalize such a practice in Canada, after a Supreme Court ruling last year that struck down laws banning physician assisted death.
Medical Research: What are the main findings?
Dr. Kim: The main findings are that:
- Most patients who receive psychiatric euthanasia and/or physician assisted suicide are women, of diverse ages, with a variety of chronic psychiatric conditions accompanied by personality disorders, significant physical problems, and social isolation/loneliness, often in the context of refusals of treatment. A minority who are initially refused EAS ultimately receive euthanasia and/or physician assisted suicide through a mobile euthanasia clinic.
- Given that the patients have chronic, complicated histories requiring considerable physician judgment, extensive consultations are common. But independent psychiatric input does not always occur; disagreement among physicians occurred in one in four cases; and the euthanasia review committees generally defer to the judgments of the physicians performing euthanasia and/or physician assisted suicide.
11 Feb Accidents, Guns and Overdoses Account For Increase in Death Rate in US Adults
MedicalResearch.com Interview with: [caption id="attachment_21326" align="alignleft" width="166"]
Dr. Andrew Fenelon[/caption]
Dr. Andrew Fenelon PhD
NIH Postdoctoral Fellow
Brown University
Medical Research: What is the background for this study? What are the main findings?
Dr. Fenelon: The life expectancy of the US population is about 2 years less than that of other high-income nations, which is an important problem in public health. Although much previous work looks at differences in death rates among older adults, some recent work has shown that deaths at younger ages (below age 50) account for a significant fraction of the life expectancy gap. Our study examines the contribution of major injuries, Motor Vehicle Crashes, Firearm-related deaths, and drug poisonings, which often occur at younger ages and account for many years of lost life.
Our findings indicate that US men and women experience significantly higher death rates from these three causes of injury death than each of the 12 comparison high-income countries. Overall, these three causes of death explained 48% of the 2.2 year life expectancy gap between the United States and other high-income countries among men, with firearm injuries alone explaining 21%. Among women, these causes explained 19%.
11 Feb Radiation Converts Some Resistant Head and Neck Cancer Cells Into Aggressive Stem Cells
MedicalResearch.com Interview with: [caption id="attachment_21484" align="alignleft" width="120"]
Dr. Erina Vlashi[/caption]
Erina Vlashi, PhD
Assistant Professor
Department of Radiation Oncology
David Geffen School of Medicine at UCLA
Los Angeles, CA 90095-1714
Medical Research: What is the background for this study? What are the main findings?
Dr. Vlashi: It has been known for quite some time that head and neck squamous cell carcinomas (HNSCC) that test positive for human papilloma virus (HPV) respond to radiation therapy more favorably than HPV-negative HNSCCs. Our team reviewed a cohort of 162 patients with a head and neck squamous carcinoma diagnosis over a two-year period, and confirmed that the outcomes were correlated with the patient's HPV status. The work that followed was prompted by a discovery we had made earlier in breast cancer suggesting that breast cancer cells that manage to survive radiation therapy have the capacity to convert into more de-differentiated, therapy-resistant cells with characteristics of cancer stem cells, and that the degree of this conversion depended on the type of breast cancer: the more aggressive types of breast cancer being more prone to the therapy-induced phenotype conversion. So, we hypothesized that this therapy-induced conversion phenomenon may especially be at play in head and neck squamous cell carcinomas given the clinical observation that HPV-positive HNSCCs respond to radiation therapy much more favorably than HPV-negative HNSCCs, despite optimum treatment modalities. And indeed, that is what we found: tumor cells derived from a panel of head and neck squamous cell carcinomas cell lines that do not respond well to radiation therapy have an enhanced ability to convert the cells that survive radiation into more aggressive cells, cancer stem-like cells that will resist the next round of radiation therapy.
11 Feb Gastric Bypass Surgery Reduces Mortality Even In Older Patients
MedicalResearch.com Interview with: [caption id="attachment_21478" align="alignleft" width="143"]
Dr. Lance Davidson[/caption]
Lance Davidson, PhD
Assistant Professor
Department of Exercise Sciences
Brigham Young University
Provo, UT 84602
Medical Research: What is the background for this study? What are the main findings?
Dr. Davidson: A growing body of literature indicates that bariatric surgery imparts a mortality benefit in severely obese individuals. Whether age at surgery affects this relationship is not well established. One might suppose that a person who has been severely obese for several decades may already have sustained enough metabolic damage that weight loss surgery would have less influence on subsequent mortality. We conducted an age-specific analysis of a previously-published mortality cohort in gastric bypass patients and severely obese controls, following them for up to 18 years (mean 7.2 years), and examined mortality rates in four age categories: under 35, 35-44, 45-54, and 55-74.
The primary finding of this retrospective cohort study was that gastric bypass surgery attenuated the age-related increase in mortality, demonstrating a widening gap in mortality risk when compared to age-matched severely obese controls as age-at-surgery increased, with a 66% reduction in mortality in the oldest group. Another interesting result, highlighted in our previous publication on this cohort (Adams et al. NEJM 2007), was a higher mortality rate from external causes (accidents, poisonings, suicides, homicides) in surgery patients. We explored this phenomenon further by age at surgery and found that externally-caused deaths were only increased in women (not men) who had surgery before age 35.
10 Feb Alcohol Impaired Driving Crimes Rise Right After Legal Drinking Age Reached
MedicalResearch.com Interview with: [caption id="attachment_21473" align="alignleft" width="170"]
Dr. Russ Callaghan[/caption]
[wysija_form id="5"]Dr. Russ Callaghan, PhD
Associate Professor
Northern Medical Program
University of Northern British Columbia
Prince George, British Columbia
Medical Research: What is the background for this study?
Dr. Callaghan: In Canada, the minimum legal drinking age (MLDA) is 18 years in Alberta, Manitoba and Québec, and 19 in the rest of the country. Given that public-health organizations not only have recommended increasing the MLDA to 19 years, but also have identified 21 years as ideal, the current study tested whether drivers slightly older than the MLDA had significant and abrupt increases in alcohol-impaired driving (AID) crimes, compared with their counterparts just younger than the MLDA. Data on the effectiveness of Canadian drinking-age laws is lacking, and the current study provides important information for the current national and international MLDA debates.
10 Feb Link Between Zika Virus, Microcephaly, Stillbirths and Miscarriages
MedicalResearch.com Interview with: Nancy Dirubbo, DNP, FNP, FAANP, Certificate in Travel Health, American Association of Nurse Practitioners (AANP) Fellow Cindy Cooke, DNP, FNP-C, FAANP, American Association of Nurse Practitioners (AANP) President of the Board Medical Research: Can you provide some background on what is the Zika virus? Response: Zika virus was first found in monkeys in the Zika Forest of Uganda in 1947 during a research project on mosquito borne viral diseases. From Africa, it spread to India, Indonesia and South East Asia over the next 20-30 years. Not much attention was paid to this illness, as it is often asymptomatic (perhaps as much as 80% of all cases). It causes few symptoms in adults (mild rash, conjunctivitis and headache) and so is often underdiagnosed or misdiagnosed as other self-limiting, viral diseases. Then fast forward to 2015, when a sudden increase in infants born in Brazil with microcephaly occurred and a connection was made with a sharp increase in Zika viral infections, even though the direct mechanism for causing this birth defect is not known. In 2014, there were less than 150 cases of microcephaly in Brazil, and by October 2015, there were 4,700 cases reported. Medical Research: What is the concern regarding pregnant women and their babies? Response: The concern for pregnant women is that there appears to be a link between Zika virus and microcephaly, still birth and miscarriages. Children who do survive have severe intellectual disabilities. The virus is most often transmitted by mosquitos, but may also be sexually transmitted. According to the CDC, “Sexual transmission of Zika virus is possible, and is of particular concern during pregnancy. Current information about possible sexual transmission of Zika is based on reports of three cases.” The CDC also recommends, “Men who reside in or have traveled to an area of active Zika virus transmission who have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex (i.e., vaginal intercourse, anal intercourse or fellatio) for the duration of the pregnancy.” It has yet to be determined if Zika virus can be transmitted in other ways, including blood transfusions.10 Feb Flu Infection Raises Risk of New Onset Atrial fibrillation
MedicalResearch.com Interview with: Tze-Fan Chao MD PhD Division of Cardiology, Department of Medicine Taipei Veterans General Hospital Institute of Clinical Medicine, and Cardiovascular Research Center National Yang-Ming University, Taipei, Taiwan Su-Jung Chen MD Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Institute of Public Health and School of Medicine, National Yang-Ming University Taipei, Taiwan MedicalResearch: What is the background for this study? What are the main findings? Response: Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice, accounting for frequent hospitalizations, hemodynamic abnormalities, and thromboembolic events. Although the detailed mechanism of the occurrence of Atrial fibrillation remains unclear, systemic inflammation and sympathetic nervous system have been demonstrated to play an important role in the pathogenesis of AF. Flu (influenza infection) is a common disease which could happen to everyone in the daily life. It could cause significant morbidity and mortality, and is a serious human health concern worldwide. Previous studies have shown that influenza infection not only results in the productions of pro-inflammatory cytokines, but also activates the sympathetic nervous system, which are all related to the occurrence of Atrial fibrillation. Therefore, we hypothesized that influenza infection could be a risk factor of new-onset AF. We also tested the hypothesis that influenza vaccination, a useful way to reduce the risk of influenza infection, could decrease the risk of AF. In this large scale nationwide case-control study, a total of 11,374 patients with newly diagnosed Atrial fibrillation were identified from the Taiwan National Health Insurance Research Database. On the same date of enrollment, 4 control patients (without AF) with matched age and sex were selected to be the control group for each study patient. The relationship between AF and influenza infection/vaccination 1 year before the enrollment was analyzed. The results showed that influenza infection was associated with an 18% increased risk of AF, and the risk could be easily reduced through influenza vaccination.10 Feb Only Small Increase in CT Screening for Lung Cancer Despite New Guidelines
Posted at 16:28h
in Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Lung Cancer, Radiology
MedicalResearch.com Interview with:
[caption id="attachment_21454" align="alignleft" width="172"]
Dr. Phillip Boiselle[/caption]
Phillip M. Boiselle, MD
Professor of Radiology and Associate Dean for Academic and Clinical Affairs
Harvard Medical School
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Medical Research: What is the background for this study?
Dr. Boiselle: We surveyed leading academic medical centers in 2013 and found considerable variability in their practice patterns as well as a relatively small number of patients being screened for lung cancer at these sites. Considering landmark developments since that time, including favorable policy and payment decisions by USPSTF and CMS and development of radiology-specific nodule guidelines by the American College of Radiology, we were curious to see whether there would be greater conformity of practice patterns and increased patient volumes in response to these developments.
Medical Research: What are the main findings?
Dr. Boiselle: First, our finding of greater conformity of lung cancer screening practices at present compared to 2013 confirmed our hypothesis that the development of radiology-specific guidelines by ACR would contribute to greater uniformity.
Second, we were surprised by the very modest level of increase in patient volumes for CT screening over time despite the favorable USPSTF and CMS decisions. We emphasize, however, that the timing of our survey occurred too early to determine the full impact of CMS coverage on patient volumes
10 Feb Some Bacteria In Stored Food Raise Markers of Inflammation
MedicalResearch.com Interview with: [caption id="attachment_21450" align="alignleft" width="160"]
Dr. Clett Erridge[/caption]
Dr. Clett Erridge PhD
Department of Cardiovascular Sciences
University of Leicester
Clinical Science Wing
Glenfield General Hospital
Leicester
Medical Research: What is the background for this study? What are the main findings?
Dr. Erridge: We have spent many years seeking potential stimuli that might be responsible for triggering the chronic inflammatory processes that underpin atherosclerosis. Our earlier work focused mainly on the questions of whether and how various molecules related to lipoprotein particles, oxidised lipids and fatty acids interacted with receptors of the innate immune system, which we believe are central players in the initiation of atherosclerosis. However, we were surprised to discover (as a result of some control experiments that we expected to yield a null result), that extracts of some, but not all, foods trigger inflammatory cytokine production in human monocytes via stimulation of the innate immune receptors Toll-like receptor (TLR)-2 and TLR4. The molecules responsible for triggering these responses (collectively termed PAMPs, 'pathogen-associated molecular patterns'), were found to arise in foods that have been finely chopped and stored at refrigeration temperature or above for some time, as a result of the growth and activity of common food spoilage bacteria. The foods most commonly affected are minced meats, ready chopped vegetables, some cheeses and chocolates.
The present study found that in 11 healthy volunteers who habitually consumed food products rich in PAMPs, switching to a low PAMP diet for 7 days resulted in an 18% reduction in LDL-cholesterol, 11% reduction in white blood cell count, a 1.5 cm reduction in waist circumference and a 0.6 kg reduction in body weight. Switching back to a high PAMP diet, in which the same volunteers were then fed meals tested and proven to be high in PAMPs, for just 4 days reversed these beneficial effects.
A second study in 13 healthy volunteers then showed that PAMPs can exert effects on white cell markers of inflammation within 24 h of consumption, when volunteers were fed either fresh or processed onion-based meals, which were nutritionally identical other than for content of bacteria and PAMPs.
10 Feb Tumor Suppressor Protein p53 Affects Progression of Rare Kidney Disease
MedicalResearch.com Interview with: [caption id="attachment_21496" align="alignleft" width="149"]
Prof. Hirofumi Kai[/caption]
Prof. Hirofumi Kai
Kumamoto University
Japan
MedicalResearch: What is the background for this study?
Dr. Kai: Alport Syndrome (AS) is a hereditary progressive kidney disease that affects 1 in 5000-10000 individuals in the US. Depending on the specific subtype and genetic mutation, the onset, symptoms and progression vary among patients. Some have earlier onset and severe phenotypes while others have slow progression towards end-stage renal disease (ESRD). The gene affected in Alport Syndrome is type 4 collagen, which codes for a protein component of the glomerular basement membrane (GBM). This mutation leads to the dysregulated proliferation (or dysplasia) of the GBM, which has an important role in urine filtration. The pathophysiological process of dysplasia indicates a dysfunction of protein/s that control cellular homeostasis. Because the tumor suppressor p53 is critically involved in modulating cell proliferation, we focused our attention on this protein.
10 Feb States That Spend More On Social Services Have Lower AIDS Deaths
MedicalResearch.com Interview with: [caption id="attachment_21438" align="alignleft" width="191"]
Dr. Talbert-Slagle[/caption]
Kristina Marie Talbert-Slagle, PhD
Lecturer in Epidemiology (Microbial Diseases) and in Public Health (Health Policy); Senior Scientific Officer, Yale Global Health Leadership Institute
Yale School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Talbert-Slagle: The interest for this study originally came as a result of work done by Elizabeth Bradley, PhD, co-author of The American Health Care Paradox. In the book, Dr. Bradley compared spending rates of social services to health care services between the U.S. and other countries and found that while the U.S. invested more money in health care services than any other country we had worse health outcomes. By contrast, countries that spent more on social services per dollar spent on health care had better outcomes.
We applied that same idea to AIDS. There are still more than 50,000 cases of HIV/AIDS diagnosed in the U.S. each year. Although many medical advances have been made in treatment and prevention of this infection, we were curious as to why rates of HIV/AIDS have remained stagnate. We wanted to explore how spending relates to differences in case rates among the states and found a significant difference among states regarding social service and public health spending related to HIV/AIDS. We looked at all 50 states’ spending habits over the past 10 years and discovered that states that invested more money in social services such as education, housing, and nutrition per person in poverty had significantly lower rates of HIV/AIDS deaths.
10 Feb HIV Continues To Disproportionately Affect African Americans
MedicalResearch.com Interview with: [caption id="attachment_21447" align="alignleft" width="133"]
Dr. Sharoda Dasgupta[/caption]
Sharoda Dasgupta, PhD, MPH
US Public Health Service and Epidemic Intelligence Service Officer
CDC
Medical Research: What is the background for this study?
Dr. Dasgupta: Roughly 1.2 million people in the United States are living with HIV, and about 40,000 diagnoses occur each year, according to the most recent CDC data.
According to national estimates published by CDC, African Americans remain disproportionately affected by the virus. African Americans represent 12 percent of the U.S. population but accounted for almost 50 percent of HIV diagnoses in 2014. Some signs have emerged that HIV is loosening its grip on the African American community, but persistent disparities are prolonging HIV transmission.
Antiretroviral therapy (ART) improves clinical outcomes for people living with HIV and reduces their risk of transmitting the virus to others. Racial and ethnic disparities in HIV care, however, limit access to ART, which perpetuates disparities in survival and HIV transmission.
Although previous studies have mostly analyzed HIV care by race and ethnicity during a single year, the purpose of this study was to better understand how people living with HIV remain in care over a longer period in time – and whether their retention in care differed by race and ethnicity.
Medical Research: What are the main findings?
Dr. Dasgupta: This analysis focused on 12 U.S. jurisdictions that reported comprehensive HIV lab results to CDC from January 2010 – December 2013. They represent approximately 25 percent of HIV diagnoses in 2010.
The findings demonstrate yet another persistent disparity that prolongs the epidemic among African Americans. Only 38 percent of African Americans received consistent HIV care from 2011 – 2013, compared with 49% of whites and 50% of Latinos. Additionally, African American males were less likely to receive consistent medical care than African American females (35 percent and 44 percent, respectively).
Among African Americans, receiving consistent HIV care was highest among those whose HIV infections were attributable to heterosexual contact. Those who received consistent HIV medical care for three years were considered consistently retained in care.
09 Feb Compilation of Mosaics Explain Differences in Male and Female Brains
MedicalResearch.com Interview with: [caption id="attachment_21428" align="alignleft" width="160"]
Prof. Daphna Joel[/caption]
Prof. Daphna Joel PhD
School of Psychological Sciences and Sagol School of Neuroscience
Tel-Aviv University
Medical Research: What is the background for this study?
Prof. Joel: The aim of the PNAS study was to test the mosaic hypothesis, published in 2011 (“Male or female? Brains are intersex”), according to which there are no “male brains” and ‘female brains” but rather brains are composed of unique mosaics of features, some more common in males and other more common in females. This hypothesis was build on animal data showing that the effects of sex on the brain may be different and even opposite under different environmental conditions (i.e., what is typical in one sex under some conditions may be typical in the other sex under other conditions).
In the Phil.Trans. paper, we use a very simple mathematical illustration to explain why the existence of sex differences is not sufficient to conclude that there are two types of brain, and how the answer to this question depends on the prevalence of ‘mosaic’ brains.
Medical Research: What are the main findings?
Prof. Joel: In the PANS study we, found differences between brains from males and brains from females, as has previously been reported. What we have done in addition, and no previous study has, is look whether brains are internally consistent, that is, have either only “male-end” features (i.e., features in the form more common in males compared to females) of only “female-end” features (i.e., features in the form more common in females compared to males). We found that internally consistent brains are much less common compared to ‘substantially variable’ brains (i.e., brains with both “female-end” and “male-end” features), and that the large majority of brains are composed of unique mosaic of “female-end”, “male-end”, and “intermediate” (i.e., common in both females and males) features. On the basis of these findings we concluded that there are no “male brains” and “female brains”.
In the Phil.Trans. paper we further suggest that human brains belong to a single highly heterogeneous population (see also Joel, 2011, Male or female? Brains are intersex), in which there may be differences between females and males in the frequencies of rare brain mosaics (e.g., brains with only “female-end” characteristics although rare in the population, are more common in females compared to males).
09 Feb Skin and Lip Cancer Risk Varies By Immunosuppression in Transplant Patients
MedicalResearch.com Interview with: [caption id="attachment_21418" align="alignleft" width="180"]
Dr. Claire Vajdic[/caption]
Claire M. Vajdic, PhD
Center for Big Data Research in Health
University of New South Wales
Australian Graduate School of Management Bldg,
Sydney Australia on behalf of the authors.
Medical Research: What is the background for this study?
Dr. Vajdic: Lip cancer is one of the most common cancers in solid organ transplant recipients. Iatrogenic immunosuppression is a strong risk factor for lip cancer but the dose-related association between individual immunosuppressive agents and risk of lip cancer has not been examined. Therefore, we investigated the association between the type, dose and duration of immunosuppressive therapy and lip cancer risk in Australian liver, heart and lung transplant recipients.
09 Feb Wheezing in Early Childhood Linked to Reduced Lung Function By Adolescence
MedicalResearch.com Interview with: [caption id="attachment_21421" align="alignleft" width="180"]
Dr. Meghan Azad[/caption]
Dr. Meghan B. Azad PhD
Assistant Professor Department of Pediatrics & Child Health and Community Health Sciences University of Manitoba and
Children’s Hospital Research Institute of Manitoba
Associate Investigator, Canadian Healthy Infant Longitudinal Development (CHILD) Study
Medical Research: What is the background for this study?
Dr. Azad: Asthma is the most common reason for children to miss school or be admitted to hospital, and accounts for over 30% of Canadian healthcare billings for children. Although many treatments exist to manage asthma symptoms, it is a lifelong disease and there is no cure. Prevention is the best approach to reduce the global burden of asthma, and our study provides important new information to inform asthma prevention strategies.
Medical Research: What are the main findings?
Dr. Azad: Wheezing is common in babies and young children. Our study looked at the long-term implications of wheezing in early life, using data from the Canadian Asthma Primary Prevention Study (CAPPS).
We followed 320 children from Winnipeg and Vancouver from before birth until adolescence, and found that specific patterns of early wheezing (from age 0 to 7) were associated with decreased lung function and increased risk for asthma by age 15.
By age 15, children who wheezed consistently through infancy and early childhood had the worst lung function (9% lower compared to non-wheezers) and the highest asthma risk (11 times higher). Even children with “transient early wheeze” (those who wheezed as babies but not as young children) had reduced lung function (5% lower) and increased asthma risk (4 times higher) as teenagers.
09 Feb Metabolically Healthy Obese Still At Increased Risk of Chronic Kidney Disease
MedicalResearch.com Interview with: Yoosoo Chang MD PhD Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul, Korea Medical Research: What is the background for this study? What are the main findings? Response: There is substantial controversy and a lot of interest on the health implications of metabolically healthy obesity, that is, subjects who are obese but do not have metabolic abnormalities in spite of their high body mass index. The risk for chronic kidney disease (CKD) among obese patients without metabolic abnormalities is unknown. In this cohort study of South Korean men and women, metabolically healthy overweight and obese participants had increased incidence of Chronic Kidney Disease (CKD) compared with normal-weight participants.09 Feb Adults With Concussion Have Increased Risk of Suicide
MedicalResearch.com Interview with: [caption id="attachment_21256" align="alignleft" width="144"]
Dr. Donald Redelmeier[/caption]
Dr. Donald Redelmeier MD, MSHSR, FRCPC, FACP
Senior core scientist at the Institute for Clinical Evaluative Sciences (ICES)
Physician at Sunnybrook Health Sciences Centre
Toronto, Ontario
Medical Research: What is the background for this study? What are the main findings?
Dr. Redelmeier: Head injury can lead to suicide in military veterans and professional athletes; however, whether a mild concussion acquired in community settings is also a risk factor for suicide is unknown.
Medical Research: What should clinicians and patients take away from your report?
Dr. Redelmeier: We studies 235,110 patients diagnosed with a concussion and found that 667 subsequently died from suicide. The median delay was about 6 years. This risk was about 32 per 100,000 patients annually, which is 3x the population norm and especially high if the concussion occurred on a weekend (from recreation) rather than a weekday (from employment).
09 Feb PSA Screening: Primary Care Doctors and Urologists Have Different Views
MedicalResearch.com Interview with: [caption id="attachment_20288" align="alignleft" width="120"]
Dr. Trinh[/caption]
Dr. Quoc-Dien Trinh MD
Assistant Professor, Harvard Medical School
Brigham and Williams Hospital
Medical Research: Please briefly explain the potential benefits and harms of PSA testing, the rationale for screening all men, and the reason U.S. guidelines now recommend against routine screening.
Response: The goal of cancer screening is to detect the disease early, and consequently treat it before it becomes more aggressive and spread to other parts of the body (which ultimately leads to death). However, cancer screening may lead to overdiagnosis (detecting cancers that would not have been a problem for a while) and overtreatment. The latter is a problem for prostate cancer, because surgery and radiation therapy (the currently accepted first-line treatments for localized prostate cancer) have significant long-term adverse effects on sexual and urinary function.
I wouldn't say that 'US' guidelines are against screening. Many professional societies continue to recommend some form of joint decision-making with regard to PSA screening. the USPSTF recommends against screening for all - they argue that the harms mentioned above outweigh the benefits.
08 Feb Just One Seafood Meal Per Week Linked To Lower Risk of Alzheimer’s Disease
MedicalResearch.com Interview with: [caption id="attachment_21402" align="alignleft" width="120"] Dr. Martha Morris[/caption] Dr. Martha Clare Morris ScD Section on Nutrition and Nutritional Epidemiology Department of Internal Medicine Rush University Medical Center Chicago, Illinois Medical Research: What is the background for this study? What are the main findings? Dr. Morris: We examined seafood consumption in a cohort of older residents of the...
08 Feb Too Much Screen time Raises Risk of Pre-Diabetes in Children
Posted at 20:59h
in Author Interviews, Diabetes, Exercise - Fitness, JAMA, Lifestyle & Health, Pediatrics
MedicalResearch.com Interview with:
[caption id="attachment_21397" align="alignleft" width="160"]
Mélanie Henderson[/caption]
Mélanie Henderson, MD, FRCPC, PhD
Pediatric Endocrinologist and Assistant Clinical Professor
Division of Endocrinology and Diabetes
University of Montreal/Centre Hospitalier Universitaire Ste-Justine
Montréal, Québec
Medical Research: What is the background for this study? What are the main findings?
Dr. Henderson: Dysregulation in insulin sensitivity and insulin secretion are the basic elements in the pathophysiology of type 2 diabetes. There is extensive data suggesting that better lifestyle habits are associated with the prevention or the delay in onset of type 2 diabetes in adults, with improved lifestyle habits having been more effective than pharmacologic agents at diabetes prevention in one study. Little work however has been done to determine whether this holds true in children. Cross-sectional studies in youth have found conflicting results and no study has considered the combined effect of physical activity, fitness and sedentary behavior on insulin dynamics in children.
Understanding the impact of lifestyle habits on insulin dynamics in childhood has become paramount, given that less than 7% of Canadian children are currently meeting physical activity guidelines and that 1/3 of school-aged Canadian children and 2/3 of Canadian teenagers are exceeding the current guidelines in terms of screen time, which advocate for a maximum of 2 hours daily.
Our study shows that adiposity is the central predictor of insulin dynamics in children, and that physical activity and screen time play an important role, in part through their effect on adiposity. Thus, establishing and maintaining a highly physically active lifestyle early on in life, while minimizing sedentary behaviour (specifically screen time) appear to be important strategies to consider to prevent type 2 diabetes in youth.
08 Feb Hip Fractures and Falls Increase Years Before Parkinson’s disease Diagnosed
MedicalResearch.com Interview with: [caption id="attachment_21392" align="alignleft" width="200"]
Helena Nyström[/caption]
Helena Nyström MD, PhD Candidate
Department of Community Medicine and Rehabilitation
Umeå University
Umeå, Sweden
Medical Research: What is the background for this study?
Response: Parkinson’s disease (PD) has an insidious onset and the prodromal phase, preceding the onset of the characteristic PD symptoms, may last for decades. Most prodromal signs previously reported are of non-motor type, such as sleep and mood disorders. However, recent studies have reported balance problems and an increased risk of accidental injuries in the last 3-5 years before diagnosis of Parkinson’s disease , and in a previous study we found a lower muscle strength at military conscription in men who were diagnosed with Parkinson’s disease three decades later. In this study, we aimed to investigate if such subtle strength deficits may translate into an increased risk of fall-related injuries.
Medical Research: What are the main findings?
Response: The median study time was 20 years before the diagnosis of Parkinson’s disease , and during this time more individuals with PD (18%) than controls (11.5%) had at least one fall-related injury. The risk was most increased in the last few years before the diagnosis of Parkinson’s disease , but a difference between the groups appeared already a decade before the PD diagnosis. The risk of hip fracture was increased during the entire study time of 26 years before the diagnosis of Parkinson’s disease .
08 Feb Checklist Based Approach Reduced Unnecessary Blood Testing During Hospitalizations
MedicalResearch.com Interview with: [caption id="attachment_21388" align="alignleft" width="160"]
Dr. Peter Yarbrough[/caption]
Peter M. Yarbrough MD
Department of Internal Medicine Division of General Internal Medicine
University of Utah Medical Center and
George E. Whalen Veteran Affairs Medical Center
Salt Lake City, Utah
Medical Research: What is the background for this study? What are the main findings?
Dr. Yarbrough: Waste is a major contributor to healthcare costs, accounting for an estimated $910 billion/year. Part of this waste includes unnecessary testing and routine laboratory testing has been recognized as frequently unnecessary for inpatients with an estimated 30-50% of tests not being needed. Through implementation of a multifaced quality improvement initiative including accurate cost feedback through the Value Driven Outcomes (VDO) the University of Utah Healthcare Internal Medicine hospitalist group was able to demonstrate a significant reduction in cost per day ($138 to $123) and cost per visit ($618 to $558) without adverse effect on length of stay or 30-day readmissions. A major component of the intervention included the use of a rounding checklist with discussion of tests required during rounds. Supporting that common laboratory tests were affected, the analysis showed a significant decrease in the number of BMP, CMP, and CBC tests per day compared to an institutional control. Estimated cost savings for this intervention were approximately $250,000 over the first year of the intervention.
08 Feb Chronic Hives and Self Reported Penicillin Allergy Often Co-Exist
MedicalResearch.com Interview with: [caption id="attachment_21384" align="alignleft" width="170"]
Dr. Susanna Silverman[/caption]
Susanna Silverman, MD
Allergy & Asthma Care of New York
Medical Research: What is the background for this study?
Dr. Silverman: Approximately 10% of the general population has self-reported penicillin allergy. Because hives and rash are often attributed to drug allergy, we began to think about certain conditions that may be confused with penicillin allergy. Chronic urticaria, which is defined as the presence of hives for six weeks or longer, is one such condition. We were interested in looking at the prevalence of self-reported penicillin allergy in patients with chronic urticaria, and the prevalence of chronic urticaria in patients with self-reported penicillin allergy.
Medical Research: What are the main findings?
Dr. Silverman: Our study found that in patients seen at the University of Pennsylvania Allergy and Immunology clinic, the prevalence of self-reported penicillin allergy in patients with chronic urticaria was approximately three times higher than in the general population. Similarly, the prevalence of chronic urticaria in patients with self-reported penicillin allergy was three times higher than in the general population. This suggests that in some patients, self-reported penicillin allergy may be due to chronic urticaria, not true drug allergy.
07 Feb Many Cancer Survivor Face Heart Elevated Disease Risk
MedicalResearch.com Interview with: [caption id="attachment_21310" align="alignleft" width="200"]
Dr. Saro Armenian[/caption]
Saro H. Armenian, DO, MPH
Associate Professor
Departments of Pediatrics and Population Sciences
City of Hope Comprehensive Cancer Center
Director of the Childhood Cancer Survivorship Clinic
Duarte, CA
Medical Research: What is the background for this study? What are the main findings?
Dr. Armenian: There are an estimated 14 million cancer survivors living in the U.S. today, and this number is expected to reach 19 million by 2024. Among these cancer survivors, nearly two-thirds will have survived more than five years beyond their cancer diagnosis, and two out of every five will be considered a ten-year survivor, contributing to a growing population of aging cancer survivors. Until now, very little was known about the cardiovascular health of adult long-term cancer survivors.
For the current study, we relied on diagnosis/procedures routinely recorded in a large integrative healthcare system that includes racially/ethnically and socioeconomically diverse members who are broadly representative of the residents in Southern California. Cardiovascular outcomes were captured from a wide variety of healthcare delivery settings (inpatient and outpatient, primary and sub-specialty care). Importantly, cancer survivors included in the current study continued to receive their primary and subspecialty care within this system well-beyond their initial cancer diagnosis (5- and 10-year retention rate: 81% and 70%, respectively), providing us with reliable population-based estimates of long-term cardiovascular disease (CVD) risk.
We found an up to 70% higher risk of CVD (ischemic heart disease, stroke, or cardiomyopathy/ heart failure) in patients diagnosed with breast, kidney, lung/bronchus, multiple myeloma, non-Hodgkin lymphoma, and ovarian cancer when compared with an age- sex- and zip-code matched non-cancer controls.
Cancer survivors who had multiple modifiable risk factors such as hypertension, diabetes, dyslipidemia were at highest risk of developing cardiovascular disease later in life, irrespective of cancer diagnosis. Importantly, cancer survivors who developed CVD were significantly more likely to die from all causes when compared to cancer survivors who did not develop CVD. While the reasons for these findings are not clear, it is possible that the presence of CVD can markedly diminish treatment options or planned duration of therapy at the time of cancer recurrence, thus compromising the optimal long-term management of a cancer patient.
06 Feb Incidence of Guillain-Barré Syndrome Rising As Zika Spreads
MedicalResearch.com Interview with: [caption id="attachment_21356" align="alignleft" width="120"]
Dr. Ken Gorson[/caption]
Dr. Kenneth C. Gorson, MD
President Elect GBS|CIDP Foundation International Global Medical Advisory Board
Guillain-Barre syndrome (GBS)
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
Medical Research: What is Guillain-Barré Syndrome? What are the main symptoms?
Dr. Gorson: Guillain-Barré Syndrome (GBS) is an immune mediated disorder affecting the peripheral motor and sensory nerves and nerve roots, and is the most common cause of rapidly progressive generalized paralysis in western countries. It is characterized by acute or subacute, progressive, symmetrical limb weakness with distal numbness or tingling in the arms and legs, and reduced or absent deep tendon reflexes in previously healthy patients. Patients notice the sudden onset of difficulty walking, climbing stairs, carrying objects and impaired fine motor skills. Balance is impaired due to sensory loss or weakness and a minority of patients develop facial weakness, trouble speaking and swallowing, and double vision. Severely affected patients may require ventilator support due to respiratory muscle weakness. Symptoms worsen over days to weeks, and most patients reach a maximum deficit (nadir) by 4 weeks, followed by a plateau phase for weeks to months, and then a recovery phase over additional weeks to months. Approximately 80 percent of patients recover to walk with minimal or no residual symptoms or functional disability. Maximal improvement usually occurs by one year, but more severely affected patients may continue to observe subtle improvements for several years after symptom onset.
In approximately two thirds of affected patients there is some preceding triggering event, classically a viral syndrome manifest as a transient upper respiratory or gastrointestinal illness with fever that resolves uneventfully prior to the onset of the neuropathy. Current evidence indicates the pathophysiology of GBS is related to molecular mimicry, where the patient's antibody response to the preceding infection interacts with a variety of antigens on peripheral nerve myelin or axons producing a generalized but multifocal inflammatory demyelinating process and associated axonal loss in some instances.
The diagnosis is established with nerve conduction studies and electromyography, which shows features indicative of a demyelinating neuropathy affecting multiple motor nerves in the arms and legs. The cerebrospinal fluid protein level is elevated without a cellular response (cyto-albuminological dissociation) in up to 80 percent of patients when performed in the first week of the illness.
Treatment is directed toward the immune response, and several large randomized controlled trials have demonstrated that intravenous immunoglobulin and plasma exchange hasten recovery, and both treatments have similar efficacy.
06 Feb Is the Evidence for the Anticoagulant Rivaroxaban Valid?
MedicalResearch.com Interview with: [caption id="attachment_21352" align="alignleft" width="194"]
Dr. Deborah Cohen[/caption]
Dr. Deborah Cohen
Associate Editor BMJ
BMA House, Tavistock Square
London
Medical Research: What is the background for this study? What are the main findings?
Dr. Cohen: Anyone familiar with warfarin understands the critical role of INR values in determining the proper dose for warfarin patients. The INR value in an individual patient is the most important piece of information a doctor considers when determining the warfarin dose. If the doctor gives too little warfarin then the patient may be at undue risk of stroke; if too much, the patient may be at undue risk of a major bleed.
The BMJ investigation revealed that the INR device used to manage the ~7,000 warfarin patients in the ROCKET trial (which served as the basis for approval of the non-valvular atrial fibrillation indication) was defective.
As such – doctors were relying upon a defective device in determining the dose of the warfarin patients – which has a direct influence on the stroke and bleeding risk in that patient. Since this was a comparative trial – any deficiency in the performance of the comparator arm (warfarin) would skew the results in favour of the study drug (rivaroxaban).
Since INR directly influences strokes and bleeds – the primary efficacy and safety endpoints – it very much questions, if not undermines, the overall results of this trial.
06 Feb Internet Delivered Cognitive Behavior Therapy Helps Some With Body Dysmorphic Disorder
Posted at 12:58h
in Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Psychological Science, Technology
[caption id="attachment_21105" align="alignleft" width="180"]
Dr. Jesper Enander[/caption]
MedicalResearch.com Interview with:
Dr. Jesper Enander
Department of Clinical Neuroscience
Karolinska Institutet
MedicalResearch: What is the background for this study?
Dr. Enander: Body dysmorphic disorder (BDD) is a common anxiety disorder affecting about 2% of the general population, and is associated with hospitalization, substance dependence and suicidality. The disorder is characterized by a intense preoccupation with perceived defects in physical appearance, despite looking perfectly normal. It is common for people with BDD to seek non-psychiatric care, such as dermatological treatment or plastic surgery, however, such treatments rarely work, and can even lead to a deterioration of symptoms.
The National Institute for Health and Clinical Excellence (NICE) in the UK recommends that patients with Body dysmorphic disorder should be offered cognitive behavior therapy (CBT), however, there is a gap between supply and demand of CBT. One way of increasing access to CBT is to deliver it using the Internet. In this randomized clinical trial we tested the efficacy of a Internet based CBT program for Body dysmorphic disorder called BDD-NET and compared it to supportive therapy.
MedicalResearch: What are the main findings?
Dr. Enander: Our study shows that BDD-NET was associated with large and significant improvements in Body dysmorphic disorder symptom severity. 56% of those receiving BDD-NET were responders (defined as at least a 30% reduction in symptoms), compared to 13% of those receiving supportive therapy. At the six months follow-up, 39% of those who received BDD-NET no longer met diagnostic criteria for Body dysmorphic disorder. No serious adverse events were reported, and most participants were satisfied with BDD-NET, despite no face-to-face contact with a therapist, and deemed the treatment as highly acceptable.
06 Feb Sitting Time Raises Risk of Type II Diabetes
MedicalResearch.com Interview with: Julianne van der Berg PhD candidate Social Medicine Universiteitssingel Maastricht The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: The study investigated in data from The Maastricht Study, a large study in the Netherlands, associations of total duration and patterns of sedentary behavior with type 2 diabetes. We show that participants with type 2 diabetes spent the most time of day sedentary, 26 min more than participants without diabetes. Each additional hour of sedentary time was associated with a 22% increased risk of type 2 diabetes. Important is that these results were independent of high-intensity physical activity.06 Feb Some Tyrosine Kinase Inhibitors Risk Greater Cardiovascular Events
MedicalResearch.com Interview with: [caption id="attachment_21344" align="alignleft" width="200"]
Dr. Jonathan Douxfils[/caption]
Jonathan Douxfils Pharm.D. - Ph.D.
Research assistant
Faculty of Medicine - Department of Pharmacy
NAmur Research Institute for LIfe Sciences (NARILIS)
Namur Thrombosis and Hemostasis Center (NTHC)
Medical Research: What is the background for this study? What are the main findings?
Dr. Douxfils: We decided to perform this study based on the release of the FDA regarding the risk of arterial occlusive events associated with ponatinib. We then hypothesize that the risk was not only restricted to ponatinib but also to other TKIs. This study shows that dasatinib, nilotinib and ponatinib increase the risk of vascular occlusive events compared to imatinib.
Medical Research: What should clinicians and patients take away from your report?
Dr. Douxfils: We suggest that patients treated with these molecules should be more frequently monitored, i.e. by an intensive support of associated comorbidities. In addition, even if they appear to have a better efficacy in terms of molecular response, new generation TKIs does not improve the overall survival at one year.
As we have not access to individual data, it was impossible to clearly identify categories of patients for whom the risk of cardiovascular occlusive events is predominant. Therefore, the intensive monitoring proposed should be applied to all patients treated with these molecules. Regarding the choice of the therapy, the physician should certainly consider the goals of the treatment. For elderly patients, improving survival is the main objective and in this context, imatinib remains an excellent choice. For patients with a life expectancy greater than 10 years in whom we aim to achieve a deep molecular response to potentially reach a point of treatment cessation, dasatinib and nilotinib could be preferred. However, the choice of dasatinib or nilotinib as first-line treatments should involve a screening for potential risk factors such as diabetes, prior vascular occlusive events or any risk that could increase these adverse events.
For second- and third-line treatments, the choice of the treatment has to be based on mutational analysis, previous adverse events, and the medical condition of the patient. Thus, in case of intolerance or resistance, the switch to one of the other TKIs approved for first-line therapy is an option. If treatment failure still occurs, a more potent TKI, i.e. bosutinib, is preferred. Importantly, ponatinib is reserved to patients with the T315I mutation and must be avoided in patients with good prognosis.