Blog – Medical Research News and Interviews
12 Jan Autism Spectrum Disorder: Comorbid Conditions Contribute To Early Mortality Risks
[caption id="attachment_20512" align="alignleft" width="150"]
Dr. Diana Schendel[/caption]
MedicalResearch.com Interview with:
Diana Schendel, Professor MSO
Department of Public Health
Institute of Epidemiology and Social Medicine and
Department of Economics and Business National Centre for Register-based Research
Aarhus University
Denmark
Medical Research: What is the background for this study? What are the main findings?
Dr. Schende: Elevated mortality has been reported in persons with autism spectrum disorder (ASD), especially with comorbid epilepsy and intellectual disability. The effect of comorbidity on the risk for mortality in ASD, however, has not been rigorously examined in large, population-based studies. Our study aim was to investigate ASD mortality patterns overall and to assess the specific effects of comorbid mental, behavioral, and neurologic disorders on ASD mortality into young adulthood. Our study comprised a nation-wide Danish cohort of 1.9 million children of whom 20,492 were diagnosed with ASD. We observed 68 deaths in persons with ASD; 83% of the persons with ASD who died had comorbid mental/behavioral or neurologic disorders. The risk for mortality was two-fold higher in persons with autism spectrum disorder overall. An elevated risk for mortality was also seen in persons who had ASD only, or had both ASD and other neurologic or mental/behavioral disorders, compared to persons without these other morbidities and no ASD. However, the co-occurrence of ASD in persons with neurologic, or with mental/behavioral disorders, added no additional mortality risk compared to persons with these disorders and no autism spectrum disorder. These results suggest that the mechanisms underlying mortality risk in ASD in part may be shared with these other disorders, although what might be the specific shared mechanisms cannot be determined with these data.
12 Jan Study Identifies PSA Level Most Likely To Predict Prostate Cancer Recurrence
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Dr. R. Jeffrey Karnes[/caption]
MedicalResearch.com Interview with:
R. Jeffrey Karnes MD
Department of Urology, Mayo Clinic,
Rochester, MN 55905
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Karnes: Cancer recurrence following radical prostatectomy is a concern for men undergoing definitive surgical treatment for prostate cancer. Approximately 20-35% of patients develop a rising prostate specific antigen following radical prostatectomy for clinically localized prostate cancer. PSA monitoring is an important tool for cancer surveillance; however, a standard PSA cutpoint to indicate biochemical recurrence has yet to be established. Over 60 different definitions have been described in literature. This variation creates confusion for the patients and clinicians. By studying a large group of patients who underwent radical prostatectomy at Mayo Clinic, we found that a PSA cutpoint of 0.4 ng/mL is the optimal definition for biochemical recurrence.
12 Jan New Breast Cancer Screening Recommendations Carry Risks Of Later Diagnosis
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Dr. Boolbol[/caption]
MedicalResearch.com Interview with:
Susan K. Boolbol, MD, FACS
Chief, Division of Breast Surgery
Chief, Appel-Venet Comprehensive Breast Service
Co-Director, Breast Surgery Fellowship
Mount Sinai Beth Israel
Associate Professor of Surgery
Icahn School of Medicine at Mount Sinai
New York, NY 10003
Medical Research: What is the background for these new recommendations?
Dr. Boolbol: To make this final recommendation, the Task Force conducted a comprehensive review of the science since its 2009 recommendation and considered the public comments it received on its 2015 draft recommendation statement. Based on all of this, the task force issued their recommendations.
Medical Research: What are the main changes from current guidelines?
Dr. Boolbol: Presently, there are several different guidelines and recommendations regarding screening mammography. Depending on the group issuing the guidelines, the recommendations vary from annual mammography beginning at 40 years old to biennial mammograms from 50 to 74 years old. The Task Force continues to find that the benefit of mammography increases with age, and recommends biennial screening in women ages 50 to 74.
12 Jan Incomplete Follow Up Rates Exceed 10% in Oral Antithrombotic Trials
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Dr. Victor Serebruany[/caption]
MedicalResearch.com Interview with:Victor Serebruany, MD, PhD
HeartDrug Research, Towson, Maryland
Department of Neurology Johns Hopkins University Baltimore, Maryland Medical Research: What is the background for this study? What are the main findings?
Dr. Serebruany: Missing data are common challenges to the validity of trial results, yet it is unclear how to characterize the extent of missing data. We compared the published lost-to-follow-up rates to incomplete follow-up rates determined from subject records submitted to the FDA for major oral antithrombotic trials. The 21 trials having both sets of rates included 270,089 patients followed for a median duration of 20 months. The mean published lost-to-follow-up rates is 0.4% (median 0.3%, range 0.005% to 2%), consistently much lower than the FDA incomplete follow-up rates: mean 12% (median 13%, range 2% to 23%). There is no correlation between the publication and FDA-calculated rates (R 0.07, p = 0.76). The FDA rates exceed greatly the endpoint rate differences: mean 1.3% (median 1,0%, range 0.2% to 3.0%). Medical Research: What should clinicians and patients take away from your report? Dr. Serebruany: That the FDA incomplete follow-up rates greatly exceed the endpoint rate differences raises questions of whether the endpoint differences may be due to differential follow-up rather than drug effect. That they greatly exceed the measures routinely reported for trials, i.e., lost-to-follow-up rates, suggests that current trial reporting is inadequate. Completeness of follow-up and other indicators of trial data quality should be considered when interpreting trial results.
12 Jan Cost and Insurance Coverage Lacking in Physician-Patient Interactions
[caption id="attachment_20562" align="alignleft" width="180"]
Dr. Paul Barr[/caption]
MedicalResearch.com Interview with:
Paul Barr MSc, PhD
Assistant Professor of Health Policy and Clinical Practice
The Dartmouth Institute for Health Policy & Clinical Practice
Medical Research: What is the background for this study? What are the main findings?
Dr. Barr: I belong to the Preference Laboratory, a group of researchers in The Dartmouth Institute for Health Policy & Clinical Practice, who focus on research to improve patient engagement in their health care. One of our areas of interest is mental health, especially depression given the high and increasing prevalence of this condition in America and worldwide. Previous research has found that individuals with depression are not fully engaged in the treatment decision making process and may not be aware of their options. Decision aids are short tools that provide information on available treatment options and information about those options that is important to patients and clinicians, which can facilitate greater patient engagement through shared decision making. To develop these tools, it is important to identify the information important to patients and clinicians when making treatment decisions.
By conducting a national survey of individuals with depression and clinicians who treat depression across the US, we found that patients and clinicians felt that the effectiveness of treatment, potential side-effects and time to recovery were important to discuss. However, where patients wanted to know about about cost and insurance coverage of treatment, clinicians did not focus on these priorities. Yet when asked to take the patient’s perspective, clinicians had the same priorities as patients, including cost and insurance coverage. In addition, only 18% of patient respondents reported experiencing a high level of shared decision making on the CollaboRATE survey (www.collaboratescore.org).
12 Jan Study Finds No Evidence of Benefit from Chromium Supplements
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Prof. Peter Lay[/caption]
MedicalResearch.com Interview with:
Prof. Peter Lay PhD
Professor of Inorganic Chemistry
School of Chemistry | Faculty of Science
Director, Vibrational Spectroscopy Core Facility
Research Portfolio
The University of Sydney
Medical Research: What is the background for this study? What are the main findings?
Response: My group has been studying the molecular mechanisms of chromium(VI)-induced cancers and the biochemistry of vanadium over the last three decades. Vanadium drugs have been in clinical trials for their anti-diabetic effects that occur via species with very similar chemistry to chromium(VI). The more we understood the biochemistry of each, the more we questioned whether the efficacies of anti-diabetic chromium(III) supplements were associated with the generation of carcinogenic chromium(VI) and chromium(V). To test this, we conducted experiments to either provide evidence for our hypothesis or disprove it. This work commenced some 15 years ago with studies on the changes in the nature of chromium(III) supplements exposed to simulated gastrointestinal juices, as well as in human and animal blood serum over times that mimicked the residence time of the supplements in the human body.
We discovered that all supplements were changed to a range of different Cr(III) species in both the GI tract and the blood.1,2 Common species were observed, but the rates at which they formed were dependent on the nature of the chromium(III) supplement. Both the supplements themselves and the chromium(III) species that formed in blood serum were partially oxidised to Cr(VI) at concentrations of the oxidant, hydrogen peroxide (a type of bleach), found in the blood of people with type II diabetes.1,2 One of the clinical features of patients with type II diabetes is increased levels of oxidants, such as hydrogen peroxide, in their blood and cells. These oxidants are associated with many of the side-effects of type II diabetes that are associated with reduced life expectancy.
These transformed chromium(III) species bound to blood proteins were more easily oxidised to chromium(VI) than the administered Cr(III) supplements. The faster a particular chromium(III) supplement reacted with blood proteins to form these easily oxidised chromium(III)-protein species, the more active was the Cr(III) supplement in its anti-diabetic activity in animal and human studies reported by other groups.1-5 According to many health and regulatory bodies, chromium(III) has minimal or no efficacy in glucose metabolism and no other beneficial effects, such as weight loss or muscle building, in well conducted human and animal trials with non-diabetic subjects. This is consistent with our proposed mechanism of action. It is only under oxidising physiological conditions associated with type II diabetes that chromium(III) can be partially transformed to sufficient concentrations of carcinogenic chromium(VI) to enable significant biological activity. In a large clinical trial where diabetic patients were treated with high doses of chromium(III) picolinate (one of the least efficacious supplements in animal studies), there was no efficacy in patients with controlled type II diabetes. Only those patients with uncontrolled type II diabetes exhibited improved glucose metabolism. These patients, who have the highest concentrations of oxidants with the ability to transform chromium(III) to chromium(VI) in blood, are therefore at the greatest risk of developing Cr-induced cancers. Even where efficacy was observed, glucose metabolism was only reduced to the levels in patients with controlled type II diabetes; i.e., no patients exhibited a return to normal glucose metabolism.4,5
Coupled with all of this information our separate studies showed that chromium(VI) and chromium(V), but not chromium(III), are strong inhibitors of protein tyrosine phosphatase (PTP) enzymes. The relevance of this is that drugs that inhibit PTPs activate circulating insulin in people with type II diabetes. That is, it causes insulin to bind more strongly to cells involved in glucose metabolism (such as fat cells) to bring about the cascade of biochemical reactions that import glucose into cells and metabolise it.1-5
Thus we were able to link all of the animal, human and in vitro studies to show that physiological conditions under which chromium(III) had the highest probability of being transformed to chromium(VI) were also those in which chromium(III) supplements were most active.1-5 Moreover, we were able to provide a mechanism of activity that required chromium(VI) and chromium(V) to be generated for insulin enhancing activity.1-5 What remained was to establish whether we could observe Cr(VI) and Cr(V) in cells treated with chromium(III) supplements. This has now been established in our most recent study6 that have just been published. Contrary to the press releases of the dietary supplement industry, the published paper was carefully planned to mimic those conditions found in vivo. The chromium(III) supplement chosen was that which had a chemical structure most closely resembling those generated in blood plasma. Thus we were able to complete the circle in linking our extensive studies on the biochemistry of chromium(III) species generated from chromium(III) supplements in the blood and show that such species were absorbed by the relevant cells and partially oxidised to chromium(VI) and chromium(V).
11 Jan Babies’ Microbiome Affected by Cesarean Section and Formula Feeding
MedicalResearch.com Interview with: Annie Gatewood Hoen, PhD Assistant Professor of Epidemiology and of Biomedical Data Science and Juliette Madan, MD, MS Associate Professor of Pediatrics The Geisel School of Medicine at Dartmouth Dartmouth-Hitchcock Medical Center Lebanon, NH 03756 Medical Research: What is the background for this study? What are the main findings? Response: When newborns are delivered they begin the process of acquiring vast numbers of bacteria that are critical for healthy nutrition and for immune training for a lifetime of health. Diseases such as obesity, heart disease, colitis, autism, and even cancer risk is associated with particular patterns in the gut microbiota; interestingly breast milk exposure is associated with decreased risk of many of these diseases. The intestinal microbiome plays a critical role in development, and delivery mode (cesarean section versus vaginal delivery) and feeding method (breast milk vs. formula) are important determinants of microbiome patterns. We observed the intestinal microbiome in 6 week old infants and how it relates to delivery type and feeding. We were particularly interested in examining patterns in the microbiome in infants who received combination feeding of both breast milk and formula, an area that has been understudied. We prospectively studied 102 infants and, with gene sequencing of bacteria, identified important patterns in microbiome composition that differed greatly based upon delivery method and between feeding groups. Babies who were combination fed (formula and breast milk) had an intestinal microbiome that was more similar to babies who were exclusively formula fed than breast fed babies. We identified individual bacteria that were differentially abundant between delivery mode and feeding groups.11 Jan Solid Organ Transplant Recipients Are At Increased Risk of Cancer Mortality
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Dr. Sergio Acuna[/caption]
MedicalResearch.com Interview with:
Sergio A. Acuna, MD
Graduate Student at St. Michael's Hospital and IHPME
University of Toronto
Medical Research: What is the background for this study?
Dr. Acuna: Solid organ transplant recipients are known to be at greater risk of developing cancers compared to the general population; however, because they are also at high increased risk of mortality from non-cancer causes, the risk of cancer morality in this population is unclear. As previous studies on this topic have reported disparate findings, the cancer mortality risk in this population remained uncertain.
Medical Research: What are the main findings?
Dr. Acuna: Our study provides conclusive evidence that solid organ transplant recipients are at increased risk of cancer mortality. Our findings demonstrate that solid organ transplant recipients are at increased risk of cancer death compared to the general population regardless of age, transplanted organ, and year of transplantation, and indicate cancer is a substantial cause of death in this population.
11 Jan Exercise and Education Prevent Back Pain, Devices Do Not
MedicalResearch.com Interview with:
Daniel Steffens, Ph.D.
The George Institute for Global Health
The University of Sydney
Medical Research: What is the background for this study?
Dr. Steffens: Back pain is a leading cause of disease burden globally. At present, a variety of interventions, such as getting a mattress that can help with back pain, exercise, education, back belts and shoe insoles, are commonly prescribed to prevent an episode of low back pain. Guidelines lack clear recommendations for prevention of low back pain and the effectiveness of the range of possible prevention strategies for low back pain is not clear. Our study aimed to investigate the effectiveness of these interventions for prevention of low back pain.
11 Jan Treatment of Sleep Disorders Reduced Congestive Heart Failure Readmissions
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Dr. Sunil Sharma[/caption]
MedicalResearch.com Interview with:
Sunil Sharma MD, FAASM
Associate Professor of Medicine
Director, Pulmonary Sleep Medicine
Associate Director, Jefferson Sleep Disorders Center
Thomas Jefferson University and Hospitals
Philadelphia, PA 19107
Medical Research: What is the background for this study?
Dr. Sharma: Congestive heart failure (CHF) is the most common cause of hospital admission and readmissions in United States. More health care dollars are spent on CHF than any other diagnosis. A large chunk of this cost is due to hospital admission. An estimated 50% of the CHF patients are readmitted within 6 months of discharge. The recent Protection Affordable Care Act (ACA) imposes penalties on hospitals for readmissions within first 30-days. It is therefore imperative to find ways to impact the natural history of the disease.
Sleep disordered breathing is a common disorder associated with CHF. It is estimated that up to 70% of the patient with CHF may have SDB. Studies have shown that untreated SDB can worsen CHF and treatment of Sleep disordered breathing has been shown to improve heart function (ejection fraction).
10 Jan 10% of Patients Receiving Implantable Defibrillators Are Frail Or Have Dementia
Posted at 12:48h
in AHA Journals, Author Interviews, Frailty, Geriatrics, Heart Disease, Johns Hopkins
[caption id="attachment_20532" align="alignleft" width="80"]
Dr. Green[/caption]
MedicalResearch.com Interview with:
Ariel R. Green, M.D., M.P.H
Assistant Professor of Medicine
Johns Hopkins University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Implantable cardioverter-defibrillators (ICDs) are widely used to prevent sudden cardiac death in patients with systolic heart failure. Older adults with heart failure often have multiple coexisting conditions and are frail, increasing their risk of death from non-cardiac causes. Our understanding of outcomes in older patients with ICDs is limited.
Medical Research: What should clinicians and patients take away from your report?
Response: Our major finding was that more than 10% of patients currently receiving ICDs for primary prevention of sudden cardiac death (meaning that they have never had a potentially lethal arrhythmia but are at risk for one, usually due to systolic heart failure) are frail or have dementia. Patients with these geriatric conditions had substantially higher mortality within the first year after ICD implantation than those without these conditions. Frailty and dementia were more strongly associated with mortality than were traditional comorbidities such as diabetes.
10 Jan Almost 90% Gastric Bypass Patients Feel Better After Surgery
MedicalResearch.com Interview with: Dr. Sigrid Bjerge Gribsholt MD, PhD Student Department of Endocrinology and Internal Medicine, Aarhus University Hospital 8000 Aarhus C Medical Research: What is the background for this study? What are the main findings? Response: Based on our clinical experiences we became aware that surgical, medical and nutritional symptoms were common in this group of patients. To enlighten the prevalence and severity we decided to undertake the study. Our main findings include that 88% of the patients felt better or much better than before surgery and 8% felt worse. Furthermore, we found that 68% of the patients had been in contact with the health care system.09 Jan CRISPR Successfully Restores Gene Function in Animal Model of Duchenne Muscular Dystrophy
MedicalResearch.com Interview with: Rhonda Bassel-Duby, Ph.D. and Dr. Chengzu Long, PhD Department of Molecular Biology UT Southwestern Medical Center Dallas, TX 75390-9148 Medical Research: What is the background for this study? What are the main findings? Response: Duchenne muscular dystrophy (DMD), which was first described by Duchenne de Boulogne (1806-1875) in 1860s, is one of the most severe and common type of muscular dystrophy. DMD is caused by mutations in the gene for dystrophin (DMD) on the X chromosome and affects approximately 1 in 3500 to 5000 boys. Without dystrophin, a large cytoskeletal protein, muscles degenerate, causing myopathy. Symptoms can be visible between 1 to 6 years old. Most Duchenne muscular dystrophy patients are confined to a wheelchair by age 12. Death of DMD patients usually occurs by age 25, typically from breathing complications and cardiomyopathy. Hence, therapy for Duchenne muscular dystrophy necessitates sustained rescue of skeletal, respiratory and cardiac muscle structure and function. Although several gene therapies have been tested, there is no curative treatment so far. Duchenne muscular dystrophy arises from a monogenic mutations in dystrophin gene. This makes DMD an ideal disease model for CRISPR-mediated gene editing therapeutics, a major breakthrough in gene engineering in the past three years. This system can remove the defect within the gene. In 2014, in a first proof of concept study, Olson’s team used CRISPR-mediated gene editing to correct the dystrophin gene mutation in the germline of DMD mouse model. In this new paper, we advanced the same technology to postnatal muscle tissues by delivery gene editing components via a harmless adeno-associated virus. Skeletal and cardiac muscle showed progressive rescue of dystrophin protein.08 Jan Medical Therapy In Patients With Severe Nasal Obstruction Likely To Fail
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Dr. Sam Most[/caption]
MedicalResearch.com Interview with:
Sam P. Most, M.D., F.A.C.S.
Professor, Departments of Otolaryngology-Head & Neck Surgery and Surgery (Division of Plastic Surgery, by courtesy)
Chief, Division of Facial Plastic & Reconstructive Surgery
Stanford University School of Medicine
Stanford, CA
Medical Research: What is the background for this study? What are the main findings?
Dr. Most: Insurance companies often require patients to try a 6 or more week treatment with nasal steroids prior to allowing nasal surgery to proceed. This is true even in cases of physician-documented severe or extreme anatomic nasal obstruction that we know will not respond to medical therapy. We sought to examine this from a cost and quality-of-life perspective.
We found that while the up-front cost of surgery is obviously much higher than medical therapy, when viewed from an effect on improvement of quality of life (or lack thereof, in the case of medical therapy), the surgical therapy became more cost effective as years passed by.
08 Jan Fetal Alcohol Syndrome Linked to 400 Comorbid Conditions
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Dr. Svetlana Popova[/caption]
MedicalResearch.com Interview with:
Svetlana Popova, M.D., Ph.Ds., M.P.H.
Senior Scientist
Social and Epidemiological Research, Centre for Addiction and Mental Health
Associate Professor, Epidemiology Division, Dalla Lana School of Public Health, University of Toronto
Associate Professor, Factor-Inwentash Faculty of Social Work, University of Toronto
Graduate Faculty Associate Member, Institute of Medical Science, University of Toronto
MedicalResearch: What is the background for this study?
Dr. Popova: It has been known for many years that prenatal alcohol exposure is associated with a number of adverse health consequences for both the mother and developing fetus. Women who consume alcohol during pregnancy place their child(ren) at risk of developing Fetal Alcohol Spectrum Disorders (FASD), and can experience a number of other adverse pregnancy outcomes including stillbirth, spontaneous abortion, premature birth, intrauterine growth retardation, and low birth weight. It was also previously known that people with FASD have many comorbidities (the simultaneous presence of two or more chronic diseases or conditions in a patient) due to the permanent damage of prenatal alcohol exposure on the fetus. However, until now it was unknown how many and what type of diseases, and at what frequencies they occur. Therefore, we reviewed the medical and epidemiological literature to identify the disease conditions that have been found to occur in people with FASD. Then based on the identified studies we estimated the pooled (combined) prevalence of the comorbid conditions found to occur among individuals with Fetal Alcohol Syndrome (FAS; the most severe and visibly identifiable form of FASD). We restricted our analysis to FAS because it is the only expression of FASD in the World Health Organization’s International Classification of Diseases, version 10 (ICD-10).
08 Jan Dermoscopy May Improve Pathology Interpretation of Skin Tumors
MedicalResearch.com Interview with: Marc Haspeslagh, MD Dermpat, Ardooie, Belgium Department of Dermatology University Hospital, Ghent, Belgium Medical Research: What is the background for this study? Dr. Haspeslagh: In daily practice, most pathology laboratories process skin biopsy specimens without access to the clinical and /or dermoscopic images. In pigmented skin tumors, this information can be crucial to process and diagnose the lesion correctly. With increasingly smaller diameter lesions undergoing biopsy, these focal changes are only visible with dermoscopy; therefore, communication of this dermoscopic information to the pathologist is important. In many dermatopathology laboratories, this communication is often insufficient or totally absent, and one can presume that these suspicious areas are often missed with the standard random sectioning technique that examines less than 2% of the tissue. To overcome this diagnostic limitation we developed in 2013 a new method for processing skin biopsies, were we routinely take an ex vivo dermoscopic image of most tumoral skin lesions. In combination with marking specific and suspected areas seen on the ex vivo dermoscopy (EVD) with nail varnish, EVD with derm dotting is a simple and easy method that brings this crucial information to the pathologist and in the slides to be examined (Am J Dermatopathol 2013; 35(8),867-869).08 Jan Obese Patients Less Sensitive To Fat Leading to Overconsumption and Weight Gain
[caption id="attachment_20494" align="alignleft" width="132"]
Prof. Keast[/caption]
MedicalResearch.com Interview with:
Russell Keast Ph.D., CFS Professor
Centre for Advanced Sensory Science (CASS)
School of Exercise and Nutrition Sciences, Faculty of Health
Deakin University
Melbourne Burwood Campus
Burwood, VIC 3125
Medical Research: What is the background for this study? What are the main findings?
Dr. Keast: Fatty acids are detected at various stages of food consumption and digestion via interactions with nutrient receptors upon the tongue and within the gastrointestinal (GI) tract. This chemoreception initiates functional responses, i.e., taste perception, peptide secretion and alterations in GI motility that play a fundamental role in food consumption, hedonics and satiety. In obesity, both GI and taste detection of fatty acids is attenuated and this may predispose individuals to increased consumption of high-fat foods, or foods containing greater concentrations of fat. In other word overweight and obese people are less sensitive to fat and this is associated with overconsumption of fatty foods leading to weight gain.
08 Jan Early Menopause Raises Risk of Postmenopausal Depression
MedicalResearch.com Interview with: Eleni Petridou, MD, MPH, PhD Marios K. Georgakis, MD Department of Hygiene, Epidemiology and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens, Greece Medical Research: What is the background for this study? Response: Previous epidemiologic studies have shown that women during their reproductive life are more vulnerable (by a factor of two) to depression than men; this has been particularly evident during peaks of intense fluctuations of ovarian hormones, like the premenstrual, perimenopausal and postpartum periods. Endogenous (natural) female sex hormones, however, have been shown in various experimental studies to possess neuroprotective and anti-depressive properties. Production of these hormones is diminished after menopause; therefore, age at menopause can be used as a proxy of the lifetime exposure to endogenous hormones. Our research hypothesis was whether longer exposure to endogenous sex hormones has a cumulative anti-depressive action, i.e., whether later age at menopause decreases the risk for postmenopausal depression.08 Jan Reducing Sugar in Beverages Can Have Major Impact on Population Health
[caption id="attachment_20446" align="alignleft" width="144"]
Kawther Hashem[/caption]
MedicalResearch.com Interview with:
Kawther Hashem MSc RNutr (Public Health)
Nutritionist and Researcher
Action on Sugar
Wolfson Institute of Preventive Medicine,
Queen Mary, University of London
London UK
Medical Research: What is the background for this study? What are the main findings?
Response: The calculations showed that a 40% reduction in free sugars added to Sugar Sweetened Beverages (SSBs) over five years would lead to an average reduction in energy intake of 38 kcal per day by the end of the fifth year. This would lead to an average reduction in body weight of 1.20kg in adults, resulting in a reduction in overweight and obese adults by approximately half a million and 1 million respectively. This would in turn prevent between 274,000-309,000 obesity-related type 2 diabetes over the next two decades. Policies such as this will reduce cases of overweight and obesity and type 2 diabetes, this will have a major clinical impact and reduce healthcare costs.
08 Jan Weight Loss and Exercise Improve Heart Failure With Preserved Ejection Fraction
[caption id="attachment_20421" align="alignleft" width="117"]
Dr. Dalane Kitzman[/caption]
MedicalResearch.com Interview with:
Dalane W. Kitzman, M.D.
Professor, Cardiology
Sticht Center on Aging
Gerontology and Geriatric Medicine
Translational Science Institute
Wake-Forest Baptist Health
Winston-Salem, NC
Medical Research: What is the background of the research?
Dr. Kitzman: Heart Failure With Preserved Ejection Fraction (HFPEF) is a relatively recently recognized disorder. It used to be thought that it was rare. However, we now realize that HFPEF is the dominant form of heart failure in America. It is also the fastest growing cardiovascular disorder. Interestingly, this disorder occurs almost exclusively among older persons, particularly women. The need is great because outcomes in persons with HFPEF (death, rehospitalization, health care costs) are worsening. This stands in contrast to most other cardiovascular disorders which are on the decline and / or are experiencing greatly improved outcomes. Remarkably, all of the large studies that have used medications in HFPEF that seemed they should be ‘sure bets’ showed no benefit for their primary outcomes. Thus, this is also the only major cardiovascular disorder where there is no proven medication treatment. That means physicians take ‘educated guesses’ in choosing treatment for this large group of patients.
The main symptom in patients with chronic HFPEF is shortness of breath and and fatigue with exertion. We showed in 2002 in JAMA that when we objectively measured this symptom with expired gas analysis (Peak VO2), this was as severely decreased in HFPEF as in patients with HFREF (severely reduced EF), the classic, well accepted form of heart failure. That and other studies helped lead to acceptance of HFPEF as a true Heart Failure disorder.
We first showed 5 years ago that 4 months of exercise training improves peak VO2 and quality of life in patients with HFPEF. In fact, exercise remains the only proven means to improve these patients’ chronic symptoms.
The goal of our study was to determine if weight loss diet also improved peak VO2 and quality of life in HFPEF patients, alone and in combination with exercise training. This was based on the under-recognized fact that over 80% of Heart Failure With Preserved Ejection Fraction patients are overweight or obese. It was already known that weight loss diet in other groups of older persons improves peak VO2 and quality of life. And small studies of weight loss surgery in the other form of HF (HFREF) suggested that weight loss can improves symptoms, peak VO2, and quality of life. However, there had never been a study of weight loss, by diet or other means, in HFPEF. In fact, it had been thought, based on observational data, that weight loss diet might be contraindicated in HFPEF.
So we recruited 100 overweight / obese patients age 60 years and older with this disorder from our community; 80% were women. The exercise was standard exercise training that we’d previously shown was effective. The meals for the weight loss diet were prepared in our metabolic kitchen by a regisered dietition. Patients made out menus selecting preferred foods. Well balanced, healthy, nutritious, but very palatable. The portions were controlled so that there was a 350 caloric deficit per day deficit, on average. Pateints made their own breakfast with guidance, unlimited of certain fruits and vegetables, and occasional “free days”, such as for holidays. Patients loved the meals and wanted to continue after the 5 month study.
07 Jan Primary Care Physicians Find It Difficult To Refuse Patient Requests For Unnecessary Medical Care
[caption id="attachment_20486" align="alignleft" width="160"]
Dr. Sapna Kaul[/caption]
MedicalResearch.com Interview with:
Sapna Kaul, Ph.D
Huntsman Cancer Institute
2000 Circle of Hope
Salt Lake City, UT 84112
Medical Research: What is the background for this study? What are the main findings?
Dr. Kaul: The United States has the highest healthcare expenditures in the world, and close to one-third of these expenditures are believed to be unnecessary. One potential reason for these unnecessary expenditures is that patients may ask for medical services that are unnecessary. At the same time, primary care physicians (PCP) could find it difficult to refuse to prescribe unnecessary medical services as they may worry that it may compromise patient satisfaction. Also, there is a shortage of primary care workforce in the U.S. and PCPs may have insufficient time to effectively address patient requests.
We investigated 2 types of unnecessary medical practices initiated by patient requests:
(1) providing unnecessary specialty referrals, and
(2) prescribing brand-name drugs when generic alternatives were available.
To explore these practices, we used data on 840 U.S. PCPs from a national survey of physicians conducted in 2009. Over 50% of primary care physicians reported providing unnecessary specialty referrals and 39% prescribed brand-name drugs at patient requests. Several provider and organizational factors, such as physician specialty and solo/2-person practice, were related to reporting unnecessary practices.
07 Jan Antibiotic Induced Depletion of Bile Acids Facilitates Growth of C. diff
[caption id="attachment_20480" align="alignleft" width="128"]
Dr. Casey Theriot[/caption]
MedicalResearch.com Interview with:
Casey M. Theriot, Ph.D.
Assistant Professor Infectious Disease
College of Veterinary Medicine
Department of Population Health and Pathobiology
North Carolina State University
Raleigh, NC 27607
Medical Research: What is the background for this study? What are the main findings?
Dr. Theriot: This study is an extension of the work we did in 2014 in our Nature Communications paper (Theriot et al. Antibiotic-induced shifts in the mouse gut microbiome and metabolome increase susceptibility to Clostridium difficile infection, 2014). We really wanted to know how different antibiotics that varied in their mechanism of action altered the gut microbiota in different ways and also in turn how this altered the bile acids present in the small and large intestine of mice. Primary bile acids are made by the host and are further converted to secondary bile acids by members of the microbiota in the large intestine. We know from previous work that secondary bile acids can inhibit the growth of C. difficile, but no one has looked in depth at the bile acid makeup in the actual gut before in the context of C. difficile. In this study we show that specific antibiotics that significantly alter the large intestinal gut microbiota and deplete all secondary bile acids allow for C. difficile to grow without any inhibition. We also showed that C. difficile spores are always germinating in the small intestine, which means in order to prevent this pathogen from colonizing the gut, we will have to target the growth of the pathogen. Moving forward the focus will be on trying to repopulate the gut with bacteria that are capable of restoring the secondary bile acid pools in order to inhibit C. difficile.
07 Jan 10% of ICU Patients At Risk of Developing PTSD
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Dr. Mayur Patel[/caption]
MedicalResearch.com Interview with:
Mayur Patel, MD, MPH, FACS
Assistant Professor of Surgery & Neurosurgery
Vanderbilt University Medical Center
Staff Surgeon and Surgical Intensivist
Nashville VA Medical Center
Medical Research: What is the background for this study?
Dr. Patel: Post-traumatic stress disorder (PTSD) can occur in patients after the traumatizing events of critical illness. Survivors of critical illness have reported PTSD symptoms months to even years after critical illness, possibly related to nightmare-like experiences, safety restraints creating communication barriers, and protective mechanical ventilation causing feelings of breathlessness and fear of imminent death. But, the epidemiology of PTSD after critical illness is unclear with wide ranging estimates (0-64%) and largely fails to distinguish past PTSD from new PTSD specifically resulting from the critical care experience.
Our study provides estimates on new cases of PTSD stemming specifically from the ICU experience. Pre-existing PTSD has rarely been systematically assessed in prior cohorts, and our work took extra effort to distinguish pre-existing PTSD from new PTSD cases. Civilian populations have dominated the literature of PTSD after critical illness, and this research is the first to also include the expanding and aging Veteran population.
07 Jan Study Finds Women Who Take Anticoagulants Can Use Hormonal Therapy
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Dr. Martinelli[/caption]
MedicalResearch.com Interview with:
Ida Martinelli MD, PhD
A Bianchi Bonomi Hemophilia and Thrombosis Center
Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Milan, Italy
Medical Research: What is the background for this study? What are the main findings?
Dr. Martinelli: Hormonal therapies are associated with an increased risk of venous thromboembolism. Patients with acute deep-vein thrombosis or pulmonary embolism require anticoagulation, but women of childbearing potential require also an adequate contraception, as oral anticoagulants cross the placenta potentially leading to embryopathy or fetal bleeding. This study was aimed to evaluate the safety of hormonal therapies together with anticoagulant therapies in terms of recurrent venous thrombosis and uterine bleeding. We demonstrated for the first time that women who take oral anticoagulants can safely use hormonal therapies, as their risk of recurrent venous thromboembolism or uterine bleeding is not increased.
07 Jan Despite Fewer Social Burdens, White Older US Men More Vulnerable To Suicide
Posted at 22:06h
in Author Interviews, Gender Differences, Mental Health Research, Race/Ethnic Diversity
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Dr. Silvia Sara Canetto[/caption]
MedicalResearch.com Interview with:
Silvia Sara Canetto, Ph.D., Professor
Faculty in the Department of Psychology, and
Affiliate Faculty in the
Center for Women's Studies and Gender Research,
Department of Ethnic Studies, and in the
Human Development and Family Studies Department
Colorado State University
Medical Research: What is the background for this study?
Dr. Canetto: In the United States, older men of European descent (so called white men) have significantly higher suicide rates than any other demographic group. For example, their suicide rates are significantly higher than those of older men of African, Latino or Indigenous descent, as well as relative to older women across ethnicities.
Behind these facts there is a cultural story, not just individual journeys of psychological pain and despair. Colorado State University’s Silvia Sara Canetto has spent a large portion of her research career seeking to uncover cultural stories of suicide.
A professor in the College of Natural Sciences’ Department of Psychology, Canetto adds a new chapter to that story in an article recently published in the journal Men and Masculinities. The article features a critical review of theories and research on suicide among older men.
07 Jan Study Finds Regular Mammography May Provide Benefit Up To Age 84
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Prof. Hennekens[/caption]
MedicalResearch.com Interview with:
Professor Charles Hennekens MD Dr.P.H
Sir Richard Doll Professor
Senior Academic Advisor to the Dean
Charles E. Schmidt College of Medicine
Florida Atlantic University
777 Glades Road
Boca Raton, FL 33431
Medical Research: What is the background for this study? What are the main findings?
Prof. Hennekens: Randomized evidence indicates clear benefits of mammography in middle age and, at present, most guidelines recommend regular mammography for women up to age 74. In collaboration with colleagues at Baylor Medical College and Meharry Medical School we were able to link the Surveillance, Epidemiology, and End Results (SEER) data to the Medicare administrative claims data. We found that, up to 84 years, screening was more common among whites than blacks and women receiving regular annual screening mammography had lower risks of mortality from breast cancer.
07 Jan Aggressive Medical Management For Patients At Highest Risk of Recurrent Stroke
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Dr. Waters[/caption]
MedicalResearch.com Interview with:
Michael F. Waters, MD, PhD
Department of Neurology
Department of Neuroscience
McKnight Brain Institute
University of Florida College of Medicine
Gainesville, Florida
Medical Research: What is the background for this study? What are the main findings?
Dr. Waters: This study was based on a subgroup of medically managed patients with severe, symptomatic, intracranial, atherosclerotic disease. Historically we know that these patients have a very high rate of additional strokes, and multiple studies have attempted to determine the best management for these patients. In SAMMPRIS, we were able to prove that aggressive medical management was superior to stenting in these patients. However, certain patients in the medically managed group still had a very high rate of repeat strokes, as much as 30% of those with certain risk factors. This study was an attempt to identify those risk factors to determine which patients were at the greatest risk for another stroke.
07 Jan Childhood Cancer Survivors At Increased Risk of Early Onset Heart Disease
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Dr. Daniel Mulrooney[/caption]
MedicalResearch.com Interview with:
Daniel A. Mulrooney, MD, MS
Cancer Survivorship
Jude Children's Research Hospital
TN 38105-3678
Medical Research: What is the background for this study? What are the main findings?
Dr. Mulrooney: This is a cross-sectional analysis performed in the St. Jude Lifetime Cohort Study (SJLIFE), an ongoing study designed to facilitate longitudinal evaluation of health outcomes among adults previously treated for childhood cancer. Following patients over the life spectrum can be challenging making it difficult to understand the long-term health effects of childhood cancer therapy. Previous studies have relied on self-report, registry, or death certificate data. Our study is novel because we clinically evaluated cancer survivors on the St. Jude campus and identified substantial, asymptomatic cardiac disease (cardiomyopathy, coronary artery disease, valvular disease, and conduction/rhythm disorders).
- Cardiomyopathy was present in 7.4% of survivors and newly identified by screening in 4.7%.
- Coronary artery disease was present in 3.8% of survivors and newly identified by screening in 2.2%.
- Valvular disease (regurgitation or stenosis) was present in 28% of survivors and newly identified by screening in 24.8%.
- Conduction or rhythm abnormalities were present in 4.4% of survivors and newly identified by screening in 1.4%.
07 Jan Study Finds No Increased Risk of Birth Defects With Birth Control Pill Exposure
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Dr. Charlton[/caption]
MedicalResearch.com Interview with:
Brittany M. Charlton, ScD
Instructor
Boston Children's Hospital and Harvard Medical School
Researcher, Harvard Chan School Department of Epidemiology
Boston, MA 02115
Medical Research: What is the background for this study? What are the main findings?
Dr. Charlton: Even though oral contraceptives can be over 99% effective with perfect use, almost 10% of women become pregnant within their first year of use. Many more women will stop using oral contraceptives when planning a pregnancy and conceive within just a few months. In both of those examples, a woman may inadvertently expose her offspring during pregnancy to exogenous sex hormones. We conducted a nationwide cohort study in Denmark in order to investigate whether oral contraceptive use shortly before or during pregnancy was associated with an increased risk of major birth defects in the offspring. Our main finding was that there was no increased risk of having a birth defect associated with oral contraceptive exposure. These results were also consistent when we broke down the birth defects into different subgroups, like limb defects.