MedicalResearch.com Interview with: David L. Katz, MD, MPH, FACPM, FACP
Director, Yale University Prevention Research Center
Griffin Hospital
Medical Research: What are the main findings of the study?Dr. Katz: We did not see any adverse effects of short-term, daily egg ingestion in adults with established coronary artery disease.
Medical Research: What was most surprising about the results?Dr. Katz: Eggs are routinely banned from 'heart healthy diets.' in particular eggs are always absent from cardiac care units, with egg beaters substituting. However, these same units routinely serve products with refined starch and added sugar. The scientific basis for excluding eggs from diets to improve cardiac health has long been suspect. Here, we show that in the short term at least, there are no discernible harms of daily egg ingestion even in adults with heart disease.
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MedicalResearch.com Interview with: Dr. Brent M. Egan MD
Professor of Medicine
University of South Carolina School of Medicine Greenville
Senior medical director of the Care Coordination Institute
Greenville, South Carolina
Medical Research: What are the main findings of the study?Dr. Egan: The study was undertaken to determine progress toward the Healthy People 2020 goals of controlling hypertension or high blood pressure in 61.2% of all adults with the condition. What we found is that hypertension control has changed very little from 2007 through 2012. In 2011-2012, an estimated 51.2% of all hypertensive adults were controlled, which is 10% below the 2020 goal. The analysis indicated that healthcare insurance and at least two healthcare visits yearly were related to both the likelihood that hypertension would be treated and controlled.
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MedicalResearch.com Interview with Marie C. Leger, MD, PhD
Ronald O. Perelman Department of Dermatology
New York University School of Medicine, New York
Medical Research: What are the main findings of the study?What was most surprising about the results?Dr. Leger: Alopecia areata is a T-cell mediated autoimmune disease. As such, there was initially hope that inhibiting the helper T cell cytokine TNF-α could effectively treat this condition. This has not been shown to be the case—in fact, one open-label study of etanercept in 17 patients with moderate to severe alopecia showed no hair regrowth and even worsening of alopecia in several subjects. There have been many other case reports in the dermatologic literature of TNF-α inhibitors causing alopecia areata. In contrast, our case report presents a patient who very clearly grew hair on adalimumab—its strength lies in the fact that her hair loss and regrowth were replicated on withdrawal and rechallenge with the medication.
Our patient’s paradoxical response to adalimumab complements other literature suggesting that there are genetic variations in the way a patient’s immune system responds to TNF-α inhibitors. In different individuals, these medications can either treat or cause conditions such as psoriasis or lupus. It seems that this is also the case with alopecia areata.
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MedicalResearch.com: Interview with:Dr. Huiyun Xiang, MD, MPH, PhD
Center for Injury Research and Policy
The Ohio State University College of Medicine, Columbus, Ohio
Jeb Phillips, BA
Project Specialist, Injury Research and Policy Staff
Nationwide Children’s Hospital, Columbus, Ohio
Medical Research: What are the main findings of the study?Response: From 2002-2012, a child younger than 6 years old experienced an out-of-hospital medication error every 8 minutes. That’s a total of 696,937 during the study period, or 63,358 per year. Almost all happened at the child’s residence. The rate and number of errors decreased with increasing age.
Analgesics were the mostly commonly involved medications (25.2%), followed by cough and cold medications (24.6%). More than 1 in 4 (27%) of the errors happened when a child inadvertently took or was given medication twice. Errors also happened when children took or were given an incorrect dose, when medication measurements were confused, and when the wrong medication was taken or given.
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MedicalResearch.com Interview with: Dr. Susanne Huijts
Research Physician at UMCU Julius Center for Health Sciences Pulmonary resident, UMC Utrecht Center
Utrecht, Netherlands
Medical Research: What are the main findings of the study?Dr. Huijts: The CAPiTA trial evaluated the efficacy of the 13-valent pneumococcal conjugate vaccine (PCV13) in adults of 65 years and older. In the per protocol analysis vaccine efficacy of 45.6% was demonstrated for the first episode vaccine type (VT) pneumococcal community acquired pneumonia (CAP); 45.0% for the first episode of non-bacteremic/ non-invasive (NB/NI) VT-CAP, and 75.0% for the first episode of VT-invasive pneumococcal disease.
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MedicalResearch.com Interview with:Dr Tsai Chung-Li
Graduate Institute of Biostatistics, College of Management, China
Medical University,Taichung, Taiwan and
Dr. Hsiao-Chuan Lin
Department of Public Health, College of Public Health, and
Department of Pediatrics,
China Medical University, Taichung, Taiwan
Medical Research: What are the main findings of the study?Response: We conducted a nationwide population-based cohort study that included two groups. Children with enterovirus infection (aged < 18 years) during 2000-2007 were identified and followed up until December 31, 2008 or until first occurrence of type 1 diabetes. The group without enterovirus infection comprised half of all insured children of the same age and without a diagnosis of enterovirus infection. By use of frequency-matching with sex and birth year, children in the group with enterovirus were selected from those eligible. This nationwide retrospective cohort study found:
type 1 diabetes is positively correlated with enterovirus infection in patients younger than 18 years.
the incidence rate of type 1 diabetes was lower in the non-enterovirus than the enterovirus group (4 vs 6 per 100,000 person-years; incidence rate ratio 1.48 [95% CI 1.19, 1.83]).
children that have been infected with enterovirus are 48% more likely to have developed type 1 diabetes.
the risk of developing type 1 diabetes is 2.18 times greater among children aged 10 years and older than among those aged younger than 1 year.
MedicalResearch.com Interview with: Adrian Baranchuk MD FACC FRCPC
Associate Professor of Medicine
Director, EP Training Program Queen's University
Kingston, Ontario, Canada
Medical Research: What are the main findings of the study?Dr. Baranchuk: In this study, we investigated whether obstructive sleep apnea increases the risk of atrial fibrillation after coronary artery bypass surgery. We found the risk to increase by approximately two-fold for patients with obstructive sleep apnea, suggesting that this disease is a strong predictor of atrial fibrillation after coronary artery bypass surgery.
We also found that the risk increases in patients with more severe obstructive sleep apnea.
This is an important association to explore since atrial fibrillation after coronary artery bypass surgery increases patient mortality, the risk of stroke, hospital stay, healthcare costs, and has substantial burden on patients and their families. It is also a common complication of the surgery, occurring in up to half of the patients. Knowing which factors increase its risk gives us a better understanding of how to manage it and mitigate its negative consequences.
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MedicalResearch.com Interview with:Arjumand Siddiqi, Sc.D., Assistant Professor
Departments of Epidemiology and Social and Behavioral Sciences
Dalla Lana School of Public Health
University of Toronto
Toronto, Ontario Canada
MedicalResearch: What are the main findings of the study?Dr. Siddiqi: The main finding of the study is that, in a society with universal health insurance (Canada), racial disparities in access to primary care are drastically reduced, with some important exceptions.
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MedicalResearch.com Interview with:John A. Naslund, MPH – PhD Student at The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH
Stuart W. Grande, PhD, MPA – Post–doctoral fellow at The Dartmouth Center for Health Care Delivery Science, Dartmouth College, Hanover, NH
Medical Research: What are the main findings of the study?Naslund: In this study we explored whether people with severe mental illness such as schizophrenia, schizoaffective disorder, or bipolar disorder, use a popular social media website like YouTube to naturally provide and receive peer support. We found that people with severe mental illness use YouTube to feel less alone and to find hope, to support and to defend each other, and to share personal stories and strategies for coping with day-to-day challenges. Dr. Grande: They also sought to learn from the experiences of others about using medications and seeking mental health care. YouTube appears to serve as a platform that helps these individuals to overcome fears associated with living with mental illness, and it also creates a sense of community among them. (more…)
MedicalResearch.com Interview with: Sara N. Bleich, Ph.D.
Associate Professor Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
Medical Research: What are the main findings of the study?Dr. Bleich: Providing easily understandable calorie information — particularly in the form of miles of walking — makes adolescents more likely to buy a beverage with fewer calories, a healthier beverage or a smaller size beverage. Adolescents were also more likely to not buy any drink at all after seeing the signs with calorie information.
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MedicalResearch.com Interview with: Prof I. Jolanda M. de Vries
Professor, Dept of Tumor Immunology
Radboud University Nijmegen
Medical Research: What are the main findings of the study?Prof. de Vries:Dendritic cells are antigen-presenting cells with the unique capacity to activate naive antigen-specific T cells, and by this means are very suitable to induce immunologic antitumor responses. Dendritic cells cultured from monocytes can be matured and loaded with tumor antigen ex vivo and administered back into the patient. Within the lymph node, dendritic cells present antigens to T cells to initiate an immune response.
Metastatic uveal melanoma patients were vaccinated with autologous DCs loaded with tumor antigens (gp100 and tyrosinase), obtained by leukapheresis, according to a schedule of 3 biweekly vaccinations. One to 2 weeks after the last vaccination, a skin test was performed to analyse the induction of immunologic responses.
We can conclude that dendritic cell vaccination is feasible and safe in metastatic uveal melanoma. Dendritic cell-based immunotherapy is potent to enhance the host’s antitumor immunity against uveal melanoma in approximately one third of patients.
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MedicalResearch.com Interview with:
Steven J. Frank, M.D.
Associate Professor of Radiation Oncology
Medical Director of the Proton Therapy CenterThe University of Texas MD Anderson Cancer CenterMedicalResearch.com Editor’s Note:
A recent research published in Oncology Payers, discusses the quality of life benefits and cost-savings of intensity modulated proton therapy (IMPT or proton therapy) with traditional x-ray therapy for advanced stage head and neck cancer. The senior author of the paper, Dr. Steven Frank, highlights two oropharyngeal cancer patients, one of whom received proton therapy and the other x-ray treatments. Both patients received chemotherapy.
The study showed that although the upfront costs of proton therapy were three times that of standard x-ray treatments, the proton therapy patient was spared the necessity of a feeding tube, nutritional and supportive care and weight loss that accompanied the x-ray treatments. By the end of the treatment period, the total care costs for the proton therapy patient were 20% lower than the x-ray treatment plan.
To evaluate the costs, Dr. Frank has been employing a costing tool used elsewhere at MD Anderson called Time-driven Activity-based Costing that places the emphasis on the value of medical care, both monetary and in terms of quality of life. Dr. Frank plans to enroll 360 patients over the next five years as well as to open the study to other cancer centers. He notes that the results will be especially valuable as health insurance companies look to further bundled insurance payments.
Dr. Frank was kind enough to answer several questions regarding his work for the MedicalResearch.com audience.
Medical Research: From a patient's perspective, what are the main differences between traditional x-ray therapy and proton therapy for cancer treatment?Dr. Frank: In proton therapy, the radiation hits the cancer, while with traditional x-ray the radiation hits the cancer and the normal tissues in the head and neck, causing more side effects during and after treatment. The main advantage is that proton therapy eliminates unnecessary radiation. As radiation oncologists, our primary goal is to effectively kill cancer while sparing the patient the side effects of excessive radiation. Proton therapy achieves this for many patients with a variety of cancers, including lymphoma, lung, head and neck, prostate, esophageal and pediatric cancers.
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MedicalResearch.com Interview with: Deborah Clegg, PhD
Research Scientist, Diabetes and Obesity Research Institute
Associate Professor, Department of Biomedical Science
Cedars-Sinai Medical Center
Los Angeles, CA 90048
Medical Research: What are the main findings of the study?Dr. Clegg:The main findings are that males and females differ with respect to how they process and respond to diets high in fat!!!! Males following consumption of a diet that is 42% of the calories coming from saturated fat (it would be analogous to eating a big mac and having a coke), gained the same amount of weight as did the females BUT the males had increased markers of inflammation in their brains and the females did not. With the elevated markers of inflammation, the males had dysregulation in glucose homeostasis and alteration in cardiovascular function – yet the females did not!!
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MedicalResearch.com Interview with:Martina Sanlorenzo, MD
Department of Dermatology
Mt. Zion Cancer Research Bldg.
San Francisco, CA 94143-0808
Medical Research: What are the main findings of the study?Dr. Sanlorenzo: In the treatment of BRAF mutant melanoma, the combination of BRAF inhibitor and MEK inhibitor has a better cutaneous safety profile compared with BRAF inhibitor monotherapy. Combination regimen shows fewer cutaneous adverse events and longer cutaneous adverse event-free interval. In particular, the development of squamous cell carcinoma or keratoacanthoma was significantly less frequent.
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MedicalResearch.com: Interview Invitation S. Akoudad, MD Msc PhD candidate
Dep. Epidemiology, Radiology, Neurology
Erasmus MC, Rotterdam , the Netherlands
Medical Research: What are the main findings of the study?Dr. Vernooij: We found that compared to never users, coumarin users had a higher prevalence of deep or infratentorial microbleeds and probably also a higher incidence of any microbleeds. A higher maximum international normalized ratio (INR) was associated with deep or infratentorial microbleeds, and among coumarin users, a greater variability in INR was associated with a higher prevalence of microbleeds.
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MedicalResearch.com Interview with:Joanna Martin, PhD student
MRC Centre for Neuropsychiatric Genetics and Genomics
Institute of Psychological Medicine and Clinical Neurosciences,
Cardiff University School of Medicine, Cardiff
Medical Research: What are the main findings of the study?
Response: In this study, we found that genetic risks which are collectively important for ADHD diagnosis also predict higher levels of traits of hyperactivity/impulsiveness, inattention and pragmatic language difficulties in childhood in the general population.
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MedicalResearch.com Interview with:Sayaka Suzuki, MD
Department of Clinical Epidemiology and Health Economics, School of Public Health, Faculty of Medicine, Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo, Japan
Medical Research: What are the main findings of the study?Dr. Suzuki:We found a slight increase in the risk of severe bleeding requiring surgery for hemostasis in children who were administrated intravenous steroid on the day of tonsillectomy.
Physicians should carefully make a decision to use steroids, taking into account patients' choice under being well informed on the risks and benefits of steroid use.
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Medical Research.com Interview with:
Terrence Loftus, MD, MBA, FACS
Medical Director, Surgical Service & Clinical ResourcesBanner HealthPhoenix, Arizona 85006
Medical Research: What are the main findings of the study?Dr. Loftus: This study demonstrated that a standardized safe surgery program effectively and systematically implemented across a diverse healthcare system resulted in a significant reduction in serious reportable events (SREs), thereby improving the quality of patient care and leading to significant cost avoidance. For the purposes of the study, SREs were defined as any reported retained surgical item, wrong site, wrong patient or wrong procedure event. Following implementation of the Safe Surgery Program there was a 52% reduction in the SRE rate in the operating rooms and L&D areas in our system. The most dramatic change and greatest area of improvement was in wrong site events which demonstrated a 70% reduction for this type of serious reportable events.
This was achieved through a Safe Surgery Program which consisted of three main components.
The first component was patient focused procedures. These are steps designed to prevent wrong site, wrong patient or wrong procedure events.
The second component was sponge, sharp and instrument count procedures. These are steps designed to prevent retained surgical items.
The final component was monthly observational audits that were performed to assess program compliance. (more…)
MedicalResearch.com Interview with: Richard M. Costanzo, PhD.
Professor of Physiology and Biophysics and
Special Assistant to the Vice President for Research
Virginia Commonwealth University
Medical Research: What are the main findings of the study?Dr. Costanzo: In this study we found that individuals with varying degrees olfactory impairment have an increased risk of experiencing a hazardous event. Those with complete loss (anosmia) were three times more likely to experience an event than those with normal olfactory function. Factors such as age,sex, and race were found to affect an individual’s risk.
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MedicalResearch.com Interview with: Daniel A. Waxman, MD, PhD
Department of Emergency Medicine
David Geffen School of Medicine
University of California, Los Angeles
RAND Corporation Santa Monica, California
Medical Research: What are the main findings of the study?Dr. Waxman:About 10 years ago, three states (Texas, Georgia, and South Carolina) passed laws which made it much harder for doctors to be sued for malpractice related to emergency room care. The goal of our research was to determine whether the lower risk of being sued translated into less costly care by emergency physicians. To figure this out, we looked at the billing records of nearly 4 million Medicare patients and compared care before and after the laws took effect, and between states that passed reform and neighboring states that didn’t change their laws. We found that these substantial legal protections didn’t cause ER doctors to admit fewer patients to the hospital, to order fewer CT or MRI scans, or to spend less for the overall ER visit.
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MedicalResearch.com Interview with:Professor Robert Insall
CR-UK Beatson Institute for Cancer Research
Glasgow UK
Medical Research: What are the main findings of the study?Prof. Insall:The principal message is that melanoma cells make their own steering signals, and thus drive themselves out of the tumour and into the bloodstream. This comes in two parts:
(a) The principal steering signal when we assay melanoma spread in vitro is lysophosphatidic acid, LPA. LPA steers cells with really remarkable accuracy; blocking LPA receptors stops them from spreading without hurting their health or ability to move.
(b) Where does the LPA gradient come from? They make it themselves. There seems to be lots of LPA around; they break down the LPA near them, leading to a gradient that's low near the cells and high further away. This is the gradient that steers the tumour cells.
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MedicalResearch.com Interview with:Craig A Umscheid, MD, MSCE, FACP
Assistant Professor of Medicine and Epidemiology
Director, Center for Evidence-based Practice
Medical Director, Clinical Decision Support
Chair, Department of Medicine Quality Committee
Senior Associate Director, ECRI-Penn AHRQ Evidence-based Practice Center, University of Pennsylvania Philadelphia, PA 19104
Medical Research: What are the main findings of the study?Dr. Umscheid: We developed an automated early warning and response system for sepsis that has resulted in a marked increase in sepsis identification and care, transfer to the ICU, and an indication of fewer deaths due to sepsis.
Sepsis is a potentially life-threatening complication of an infection; it can severely impair the body’s organs, causing them to fail. There are as many as three million cases of severe sepsis and 750,000 resulting deaths in the United States annually. Early detection and treatment, typically with antibiotics and intravenous fluids, is critical for survival.
The Penn prediction tool, dubbed the “sepsis sniffer,” uses laboratory and vital-sign data (such as body temperature, heart rate, and blood pressure) in the electronic health record of hospital inpatients to identify those at risk for sepsis. When certain data thresholds are detected, the system automatically sends an electronic communication to physicians, nurses, and other members of a rapid response team who quickly perform a bedside evaluation and take action to stabilize or transfer the patient to the intensive care unit if warranted.
We developed the prediction tool using 4,575 patients admitted to the University of Pennsylvania Health System (UPHS) in October 2011. We then validated the tool during a pre-implementation period from June to September 2012, when data on admitted patients was evaluated and alerts triggered in a database, but no notifications were sent to providers on the ground. Outcomes in that control period were then compared to a post-implementation period from June to September 2013. The total number of patients included in the pre and post periods was 31,093.
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MedicalResearch.com Interview with: Cathryn Bock, PhD
Associate Professor, Oncology Department
Karmanos Cancer Institute
Wayne State University School of Medicine
Detroit, MI 48201
Medical Research: What are the main findings of the study?
Dr. Bock:This study examined the association between dietary antioxidant micronutrients and risk of renal cell carcinoma (RCC) among a cohort of 96,196 postmenopausal women from the Women’s Health Initiative (WHI). During follow-up (median follow-up time was 12 years), there were 240 cases of confirmed renal cell carcinoma in the cohort. Dietary lycopene intake, measured at baseline, was associated with a decreased risk of renal cell carcinoma (RCC). Women with the highest quartile of lycopene intake (>6427.7 mcg/day) had approximately 40% lower risk of RCC compared to those women in the lowest quartile of lycopene intake (<2727.6 mcg/day). There were no statistically significant associations observed between intake of beta-carotene, alpha-carotene, beta-cryptoxanthin, lutein + xeazanthin, vitamin C, or vitamin E and renal cell carcinoma.
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MedicalResearch.com Interview with:Dr. Brian Rostron PhD, MPH
Center for Tobacco Products
US Food and Drug Administration
Silver Spring, Maryland
Medical Research: What are the main findings of the study?Dr. Rostron: We estimated that Americans in 2009 had had 14 million major medical conditions such as heart attack, stroke, lung cancer, and COPD that were attributable to smoking. COPD was the leading cause of smoking-attributable morbidity, with over 7.5 million cases of COPD attributable to smoking.
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MedicalResearch.com Interview with: Andre Kalil, M.D., M.P.H.
Professor of Medicine
Director, Transplant ID Program
University of Nebraska Nebraska Medical Center
Omaha, NE 68198-5400
Medical Research: What are the main findings of the study?Dr. Kalil: In recent years, physicians treating staph infections with vancomycin have seen an increase in the minimum inhibitory concentration (MIC), the lowest concentration of an antimicrobial agent that inhibits the growth of a microorganism. This condition is referred to as vancomycin “MIC creep.” It is an indicator that the bacteria might be developing a reduced susceptibility to vancomycin. There also have been reports suggesting that elevations in vancomycin MIC values may be associated with increased treatment failure and death.
To determine the effectiveness of vancomycin and other newer antibiotics used to treat Staphylococcus aureus, the UNMC team analyzed nearly 8,300 episodes of Staphylococcus aureus bloodstream infections from patients around the U.S. and in several other countries. The adjusted absolute risk of mortality among patients with Staphylococcus aureus bloodstream infections with high-vancomycin MIC was not statistically different from patients with Staphylococcus aureus bloodstream infections with low-vancomycin MIC.
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MedicalResearch.com Interview with:Phil Tully PhD
Early Career Research Fellow, Discipline of Medicine
University of Adelaide Australia and
Abteilung für Rehabilitationspsychologie und Psychotherapie
Institut für Psychologie, Universität Freiburg Freiburg Germany
Medical Research: What are the main findings of the study?Response: The systematic review indicated that anxiety disorders ascertained by clinical interview are highly prevalent in patients with verified coronary heart disease. Also, approximately 50% of anxiety disorders were comorbid with depression. There was however some uncertainty in prevalence estimates with high level heterogeneity observed between studies. It was also evident that studies measuring generalized anxiety disorder in outpatient samples reported an increased prognostic risk for major adverse cardiac events in the longer term, when adjusted for confounding factors, however there was limited data. There were no randomized controlled trials targeting anxiety disorders in this population.
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MedicalResearch.com Interview with:
Donna Tepper, M.D.
Henry Ford Hospital
Medical Research: What are the main findings of the study?Dr. Tepper:We looked at 94 patients who underwent bariatric surgery at Henry Ford from 2003 through 2013. Of those, 47 subsequently had body recontouring procedures, such as body lift, abdominoplasty (tummy tuck), arm lift, thigh lift, face lift. We recorded the patients’ body mass index prior to bariatric surgery, and then again at 6 months, 1, 2.5, 4, and 5 years. Of the patients who underwent contouring surgery, the average decrease in BMI was 18.24 at 2.5 years, compared to a statistically significant 12.45 at 2.5 years for those who did not have further surgery. This is statistically significant. This 3 point change in BMI is an 18-21 pound difference depending on patient height. Furthermore, the BMI in the body contouring group continues to be lower at 4 and 5 years from bariatric surgery compared to the bariatric surgery alone group. (more…)
MedicalResearch.com Interview with: Elvira Cicognani PhD
Department of Psychology
School of Psychology and Education, University of Bologna
Piazza Aldo Moro, 90 - Cesena, Italy -
Viale Berti Pichat, 5 - Bologna, Italy
Medical Research:What are the main findings of the study?Dr. Cicognani:The study is part of a larger project of the Italian National Transplant Center (Centro Nazionale Trapianti, CNT), started in 2008, in collaboration with Istituto Superiore di Sanità, Centro Studi Isokinetic, University of Bologna, Cimurri Impresa e Sport and Patients’ associations. The general aim is to encourage transplant patients to practice physical activity and even sport activity, in view of its benefits in enhancing recovery and quality of life after transplantation.
In this study we assessed Health-related quality of life on 118 active kidney transplant patients practicing different sports at low to moderate intensity and compared them with those of 79 sedentary kidney transplant patients and with 120 active healthy control subjects.
Active transplant patients reported higher levels of quality of life than sedentary patients on most dimensions of quality of life and similar to active healthy controls. In brief, practicing sports may allow patients to achieve a level of quality of life similar to the general population of active individuals.
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MedicalResearch.com Interview Invitation Sara N. Bleich, Ph.D.
Associate Professor
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Baltimore, MD 21205
Medical Research: What are the main findings of the study?Dr. Bleich: Large chain restaurants appear to be voluntarily reducing the calories in their newly introduced menu items which contain an average of 60 fewer calories than items only on the menu in the prior year. This decline is primarily driven by new lower calorie salads and sandwiches.
(more…)
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