Blog – Medical Research News and Interviews
13 May HPV Vaccination of Boys Can Yield Substantial Health Benefits
MedicalResearch.com Interview with: Dr. Johannes Berkhof Department of Epidemiology and Biostatistics, VU University Medical Centre Amsterdam Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Vaccination against the sexually transmitted human papillomavirus (HPV) is offered free-of-charge to 12-year-old girls in the Netherlands. There is strong evidence that HPV also causes cancer in men: the virus is associated with cancers of the penis, anus, and oropharynx, and possibly with a small proportion of oral cancers. A number of these cancers will be prevented because vaccination of girls leads to a decrease of HPV in the general population and thus provides indirect protection to heterosexual men. However, vaccine uptake among girls is only about 60 percent in the Netherlands. Moreover, men who have sex with men are at increased risk of HPV-related cancer and will not be protected by vaccination of girls. On the basis of data from several epidemiological studies and a dynamic model for virus transmission, we calculated that, if the vaccine uptake is low, about 200 girls need to be vaccinated to prevent one case of cervical cancer and 470 boys need to be vaccinated to prevent one case of cancer in men. An increase in vaccine uptake in girls will decrease the HPV infection risk in heterosexual men and if the uptake in girls is 60 percent, around 800 boys need to be vaccinated to prevent one additional case of cancer in men.13 May Dietary Restriction Provides Benefits Beyond Weight Loss
MedicalResearch.com Interview with: Edward "Ted" Weiss, Ph.D. Associate Professor Department of Nutrition and Dietetics Saint Louis University Saint Louis MO Medical Research: What is the background for this study? What are the main findings? Dr. Weiss: Results from one of our previous study yielded a surprising result that diet-induced weight loss improved insulin sensitivity (major diabetes risk factor) by the same amount as exercise induced weight loss. We thought that the exercise-induced weight loss would have yielded benefits from the weight loss itself but also from a weight loss-independent benefit that has been reported in other studies. One explanation for dietary restriction providing the same benefit of exercise was that it also provides benefits besides those that are attributable to weight loss. Our recently completed/published study was designed to evaluate this possibility and the finding do suggest what we hypothesized... i.e. that dietary restriction provides benefits above and beyond that which are attributable to weight loss.12 May UK Primary Care Reforms Resulted In More Unplanned Hospital Admissions For Children
MedicalResearch.com Interview with: Elizabeth Cecil, MSc Department of Primary Care and Public, Health, Imperial College London London, United Kingdom Medical Research: What is the background for this study? What are the main findings? Response: Unplanned hospital admissions in children have been rising for more than a decade placing strain on health care resources in the UK. Unnecessary hospital admission exposes children to hospital acquired infections and an over invasive approach, and is inconvenient for their families as well as adding to pressures on staff dealing with sicker children. Our team from Imperial College London were interested in assessing the impact of primary care policy reforms on short stay admissions, in England. The reforms were nationally implemented in April 2004 and reduced the availability of primary care physicians for children. Our study, found that reforms coincided with an increase in short-stay admission rates for children with primary care-sensitive chronic conditions and with fewer children’s admissions being referred by a primary care physician. Over the study period from April 2000 to March 2012, we found that more than half of the 7.8 million unplanned hospital admissions for children younger than 15 years were short-stay admissions for potentially avoidable infections and chronic conditions. The primary care policy reforms implemented in April 2004 were associated with an 8 percent increase in short-stay admission rates for chronic conditions, equivalent to 8,500 additional admissions, above the 3 percent annual increasing trend. Notably, the policy reforms were not associated with an increase in short-stay admission rates for infectious illness.12 May Rising Number Of Heart Infections Due To Staphylococcus Bacteria
MedicalResearch.com Interview with:
J L Mehta, MD, PhD
Professor of Medicine and Physiology and Biophysics
Stebbins Chair in Cardiology
University of Arkansas for Medical Sciences
Little Rock, AR 72205
Medical Research: What is the background for this study? What are the main findings?
Dr. Mehta: In 2007, ACC/AHA published new guidelines regarding infective endocarditis (IE) prevention. This guideline drastically differed from the way we practiced and prescribed antibiotics to our patients when they undergo surgery or any other procedure like dental procedure, endoscopy, etc. to prevent infective endocarditis. As a result of these guideline, antibiotic use is now being restricted to only a small number of patients who have cardiac conditions that puts them at very high risk for adverse outcomes from IE. However, there is paucity of data on IE trends in the community following such a major change in practice. Therefore evaluated the trend in incidence of infective endocarditis and their outcomes before and after the advent of new guideline.
Our study has several important findings.
First, there has been a steady increase in the incidence of infective endocarditis hospitalizations over the last decade in the US. However, the incidence of IE pre- and post-inception of new antibiotic prophylaxis guidelines is not significantly different. In parallel to these findings, the rate of valve replacement for infective endocarditis did not change after the release of new guidelines in 2007.
Secondly, the increase in IE incidence was seen across all types of pathogens- Staphylococcus, Streptococcus, gram negative bacteria and fungi. The major offender involved in IE in the United States is Staphylococcus.
Finally, the rate of Streptococcus infective endocarditis related hospitalization increased significantly following the release of new guideline in the US, while Staphylococcus IE hospitalizations although on rise, did not increase significantly following the 2007 ACC/AHA guideline update.
12 May To Stay Healthy: “Keep your waist to less than half your height”
MedicalResearch.com Interview with: Dr Margaret Ashwell OBE, FAfN, RNutr (Public Health) Ashwell Associates Ashwell, Hertfordshire, United Kingdom. Visiting Research Fellow, Oxford Brookes UniversityMedicalResearch: What are the main findings from this study?
Dr. Ashwell: In this study, the authors explore the differences in CVD risk factors between overweight and non-overweight people (by BMI) according to their shape (waist-to-height ratio -WHtR) Data for their analysis was taken from the Health Survey for England 2009 (HSE). They found significant differences in levels of total cholesterol (TC) and glycated haemoglobin (HbA1c—a measure of blood sugar control used to diagnose diabetes). Out of 2917 people aged 16 years and over, 346 classified as ‘normal’ by BMI, have WHtR exceeding 0.5 (12% of the total,sample, or 34% of normal weight people). These could be called non-overweight ‘apples’, who have a lot of fat around the waist but not a high BMI. The researchers classified the HSE population into four groups (2×2) using standard boundary values of BMI (above or below 25kg/m2) and WHtR (above or below 0.5). The group with ‘low/normal BMI but high WHtR (non-overweight ‘apples’) had significantly higher mean TC than the group with high BMI but low WHtR (overweight ‘pears’—people with a higher than normal BMI but less fat around the waist): 5.73mmol/L vs. 4.98mmol/L. Similarly, HbA1c levels were higher among non-overweight ‘apples’ than among overweight ‘pears’ (5.62% vs. 5.33%). These differences were similar and also significant in both sexes.MedicalResearch: Why do you say that piece so string can be used for primary screening?
Dr. Ashwell: Since a good boundary value for waist-to-height ratio is 0.5, you don't even need a tape measure to screen those at risk. It can be done with a piece of string. Measure the height of child with string, fold it in half and see if it fits around his/her waist. If it doesn't, that child should proceed to the next stage of screening.12 May Negative Ultrasound Study Can Rule Out Upper Extremity DVT
MedicalResearch.com Interview with: Dott. Michelangelo Sartori U.O. di Angiologia e Malattie della Coagulazione Azienda Ospedaliera di Bologna Policlinico Sant'Orsola Malpighi Bologna Medical Research: What is the background for this study? What are the main findings? Response: The safety of withholding anticoagulation only on the basis of ultrasound imaging has not been evaluated in patients with suspected (Upper Extremity Deep Vein Thromobsis) UEDVT. The purpose of this management study was to evaluate the failure rate of ultrasound testing for UEDVT diagnosis in outpatients. Our data show that, similarly to the lower extremity, a negative complete ultrasound assessment of the upper extremity can safely exclude DVT. We found a 3-month VTE rate of 0.6% after a negative ultrasound and such figure is not different from the 3-month VTE incidence in management studies for lower limb DVT. Thus anticoagulant therapy can be withheld for clinically suspected UEDVT after negative ultrasound examination without further testing in the ambulatory office setting.12 May Emergence and Persistence of Obesity in Mid-childhood Is Found To Be High
MedicalResearch.com Interview with:
Matthew Pearce
NHS Gloucestershire Clinical Commissioning Group
UK
Medical Research: What is the background for this study? What are the main findings?
Response: Despite evidence to suggest that the prevalence of childhood obesity in the UK has stabilized in recent years, we know that approximately one in five children start their school life either overweight or obese, increasing to one in three children by the last year in primary school. Our research was the first to undertake an in-depth analysis on the UK’s National Child Measurement Programme (NCMP) and retrospectively track the weights of individual children over a 7-year period. Our study included a sample of 1863 children in South Gloucestershire, Bristol in the UK.
Our results were found to be similar to cross sectional data with obesity prevalence approximately doubling between the first (4/5yrs old) and last year (10/11yrs old) of primary school. Our findings provide little reassurance that those children who are obese in early childhood ‘grow out of ’ excess adiposity. Including overweight, we found that 84% of obese children at Reception year went on to be either overweight or obese by Year 6. Although previous studies have failed to identify any significant differences in BMI change between boys and girls during mid-childhood, our research found that more boys than girls dropped a weight category (from overweight or obese) by the time they reached Year 6. We found that the odds ratios of being overweight (BMI ?85th percentile) or obese (?95th percentile) based on BMI at Reception were similar to published literature. Our data found children who are within the upper range of the healthy weight category (75th–85th percentile) at Reception had an increased risk of being overweight or obese by the time they reach year 6.
12 May Dexamethasone May Limit Kidney Failure After Heart Surgery
MedicalResearch.com Interview with: Kirolos A. Jacob, MD, MSc PhD Candidate Division Vital Functions, Cardiothoracic Surgery and Intensive Care Medicine University Medical Center Utrecht Medical Research: What is the background for this study? What are the main findings? Dr. Jacob: Heart surgery carries many risks for a patient undergoing such a procedure. One of the most devastating complications following open heart surgery is kidney failure requiring dialysis. Most of these patients who develop kidney failure requiring dialysis after surgery have some form of chronic kidney disease before the operation, which placed them at especially high risk. Approximately one out of every 100 patients undergoing open heart surgery develops severe kidney failure. When such kidney failure occurs, the patient has more than 40% chance of dying. 1% sounds like a small percentage, however given the fact that each year, over half a million people undergo heart surgery in the USA alone, this means that an estimated 5,000 patients develop renal failure and of those about 2,500 die as a result of this complication. This figure is rising yearly as more and more patients are being operated due to the aging population. Also, this elderly population has often significant pre-existing kidney disease, further increasing the incidence of kidney failure after a heart operation. Thus, treatment strategies are needed for this relatively small yet very important and expanding group of patients. Heart surgery initiates an inflammatory reaction across the human body due to the surgical trauma and the heart-lung machine. This systemic immune system reaction is thought to play a vital role in the development of kidney injury after heart surgery. Our study investigated the effects of dexamethasone, a strong anti-inflammatory drug, on severe kidney injury after heart surgery. Severe kidney injury was defined as the use of dialysis during the hospital stay after surgery. We discovered that patients who receive the drug used 56% less frequently kidney dialysis, when compared to those receiving a placebo. Thus patients who did not receive the drug had about 2.5x higher risk for developing kidney failure when compared to those receiving dexamethasone. The beneficial effects of dexamethasone were particularly present in those who already had pre-existing kidney disease before heart surgery. This reinforces the fact that this drug could be of major importance for the increasing elderly population with pre-existing kidney disease undergoing a heart operation.11 May Genetic Variants Explain Differences in Age Of Onset Of Huntington’s Disease Symptoms
Posted at 20:08h
in Author Interviews, Genetic Research, Karolinski Institute, Nature, Neurological Disorders
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Photo: Ulf Sirborn[/caption]
MedicalResearch.com Interview with:
Kristina Bečanovič Ph.D.
Department of Clinical Neuroscience
Karolinska Institutet, Stockholm, Sweden
Medical Research: What is the background for this study?
Dr. Bečanović: While the symptoms normally debut in middle-age, there is wide individual variation in how Huntington disease manifests itself, and even though two people carry the exact same genetic mutation that codes for the huntingtin protein, there can be up to a 20-year difference in onset of motor symptoms. This suggests that genetic variants, transcription factors and environmental factors could contribute to the observed differences in disease expressivity. As the identification of regulatory factors of the huntingtin gene would be targets for therapeutic intervention, we set out to study the regulation of the huntingtin gene as it has not been well-known which factors regulate the expression levels. We were interested in identifying both genetic variants and transcription factors that are of importance for gene regulation. We therefore used DNA from Huntington disease patients to study the regulation of the huntingtin gene promoter in cells.
11 May Wide US Regional Variation In Organ Donation Rates
Posted at 19:49h
in Author Interviews, Gastrointestinal Disease, Transplantation, University of Pennsylvania
MedicalResearch.com Interview with:
Dr. David Goldberg MD, MSCE
Assistant Professor of Medicine
LDI Fellow, Leonard Davis Institute, University of Pennsylvania
Medical Director for Living Donor Liver Transplantation, Hospital of the University of Pennsylvania
Senior Scholar, Center for Clinical Epidemiology and Biostatistics
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Goldberg: While there are data that demonstrate differences in authorization (consent) rates for deceased donation among racial and ethnic minorities, it is unknown how these differences contribute to geographic differences in the number of deceased organ donors. It has been postulated that geographic differences in the distribution of racial and ethnic minorities may contribute to differences in the deceased organ supply, yet there have been no empiric data to support this. Using data on “eligible deaths,” defined as potential brain-dead organ donors <=70 years of age, we demonstrated that even after accounting for differences in the racial/ethnic demographics of the potential donor population, there are dramatic differences in authorization (consent) rates across geographic areas that are not explained by demographics alone. If the source of these differences could be identified, then there could be large increases in the number of organ donors, and lifesaving transplants, in areas with lower authorization rates.
11 May Nondisclosure Agreements in Medical Malpractice Settlements May Limit Transparency
MedicalResearch.com Interview with:
William M. Sage MD JD
James R. Dougherty Chair for Faculty Excellence
School of Law
The University of Texas
Medical Research: What is the background for this study? What are the main findings?
Response: We reviewed settlement agreements in malpractice claims closed by The University of Texas System as part of a larger study on incorporating patient perspectives into safety improvement funded by the Agency for Health Care Research and Quality. Over the five years studied, we found that 88.7% of the 124 settlement agreements that met our study criteria contained non-disclosure provisions, but with little standardization or consistency. Restrictions on disclosure, which selectively burdened patients and their families, seemed broader than needed to protect health care providers from disparagement or to avoid attracting additional litigation. Medical malpractice could happen to anyone at any time during your visit to your hospital. If you or a member of your family have been the victim of medical palpractice you might want to look into getting help from someone like this Tate Law Offices Ft. Worth Personal Injury Law Firm or a law firm that is local to you that might be able to help with your case.
Nearly half of the agreements (46.4%) prohibited disclosure of the underlying facts, which may be inconsistent with emerging principles of patient safety and compassionate care, and 26.4% prohibited reporting to regulatory bodies, a restriction that the health system subsequently eliminated in response to our findings. Settlements reached after tort reform took full effect in Texas had stricter non-disclosure provisions than earlier settlements, suggesting greater leverage by defendants notwithstanding the reduced risk of additional litigation.
11 May Moderate Wine Intake In Diabetes May Improve Glucose Metabolism
MedicalResearch.com Interview with:
Meir Stampfer, MD, DrPH
Professor of Medicine, Harvard Medical School
Professor of Epidemiology and Nutrition
Harvard T.H. Chan School of Public Health
Assoc Director, Channing Division of Network Medicine
Department of Medicine, Brigham and Women's Hospital
Boston, MA
Medical Research: What is the background for this study? What are the main findings?
Response: Moderate alcohol has repeatedly been linked to lower risk of developing diabetes, and among diabetics, those who drink moderately at at substantially lower risk for cardiovascular outcomes. However, there have been no long term trial of alcohol among diabetics. In this two-year randomized trial, we found that wine caused modest improvements in glucose metabolism and in blood lipid levels, with a somewhat greater benefit observed for red wine, for changes in lipids.
11 May Red Blood Cell Surface Molecule May Be Target For New Malaria Vaccine and Treatment
MedicalResearch.com Interview with:
Manoj Duraisingh Ph.D.
John LaPorte Given Professor of Immunology and Infectious Diseases
Harvard T.H. Chan School of Public Health
Department of Immunology and Infectious Diseases
Boston, Massachusetts
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Duraisingh: The malaria parasite P. falciparum is one of the most important pathogens of humans, with enormous mortality resulting from blood-stage infections, when parasites replicate exponentially in red blood cells. Although anti-Plasmodial drugs are in clinical use, widespread and increasing parasite drug-resistance has contributed to an ongoing public health crisis, and we urgently need to find novel approaches to prevent and treat disease.
Targeting host red blood cell molecules presents an unexploited alternative. However, the highly differentiated and enucleated red blood cell poses a significant technical hurdle for genetic experimentation, due to the lack of a nucleus.
Here we have developed a novel, forward genetic screen to identify critical factors of malaria infection of red blood cells in an unbiased fashion. Our screen takes advantage of recent advances in human stem cell biology that enable the ex vivo culture of red blood cells from nucleated hematopoietic precursors which are amenable to in vitro genetics.
We have now identified a surface molecule CD55 (alias Decay-Accelerating Factor, DAF) as an essential host factor required for the invasion of red blood cells by P. falciparum. We demonstrate that this protein is required by all P. falciparum strains tested (laboratory and field) for invasion. Furthermore, we demonstrate that CD55 acts at the initial stage of invasion when the P. falciparum parasite attaches to the surface of the red blood cell.
Collectively, our findings indicate that CD55 is an ideal target for the development of new host-directed and vaccine therapeutics for malaria.
11 May Electronic Medical Records Did Not Improve Stroke Outcomes Or Quality Of Care
Posted at 14:03h
in Author Interviews, Brigham & Women's - Harvard, Electronic Records, JACC, Stroke
MedicalResearch.com Interview with:
Karen E. Joynt, MD MPH
Cardiovascular Division,
Brigham and Women's Hospital and VA Boston Healthcare System
Department of Health Policy and Management
Harvard T.H. Chan School of Public Health
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Joynt: While there is a great deal of optimism about the potential of Electronic Health Records (EHRs) to improve health care, there is little national data examining whether hospitals that have implemented EHRs have higher-quality care or better patient outcomes. We used national data on 626,473 patients with ischemic stroke to compare quality and outcomes between hospitals with versus without EHRs. We found no difference in quality of care, discharge home (a marker of good functional status), or in-hospital mortality between hospital with versus without EHRs. We did find that the chances of having a long length of stay were slightly lower in hospitals with EHRs than those without them.
11 May Breast Cancer Risk Reduction of Prophylactic Salpingo-Oophorectomy May Be Overestimated For Some BRCA1 Carriers
MedicalResearch.com Interview with:
Bernadette A.M. Heemskerk-Gerritsen, Ph.D.
Department of Medical Oncology
Erasmus MC Cancer Institute
Roterdam, the Netherlands
Medical Research: What is the background for this study? What are the main findings?
Dr. Heemskerk-Gerritsen: Women with a BRCA1 or BRCA2 mutation have substantially higher risks of developing both primary and contralateral breast cancer (BC) and ovarian cancer than women from the general population. Options to reduce these increased cancer risks include risk-reducing mastectomy (RRM) and/or risk-reducing salpingo-oophorectomy (RRSO). The latter intervention obviously reduces the risk of developing ovarian cancer, but has been reported also to reduce the risk of developing a subsequent breast cancer with approximately 50%. However, studies on the efficacy of risk-reducing surgery in BRCA1/2 mutation carriers are confined to observational studies, thus challenging several methodological issues. Consequently, previous studies on breast cancer risk-reduction after RRSO may have been influenced by bias associated with selection of study subjects, bias associated with start of follow-up, or by confounding, and breast cancer risk-reduction may have been overestimated.
In the current study, we revisited the association between risk-reducing salpingo-oophorectomy and breast cancer risk in BRCA1/2 mutation carriers, focusing on the impact of different analytical methods and potential types of bias.
First, we replicated the analyses of four previously performed studies, to examine if our Dutch cohort was comparable with the cohorts used in the previous studies. We replicated the approximately 50% breast cancer risk reduction after RRSO in the Dutch cohort.
Second, we estimated the effect of RRSO on breast cancer risk in the Dutch cohort using a revised analytical approach for observational studies in BRCA1/2 mutation carriers in order to minimize bias as much as possible. Using this method of analysis, we found no evidence of first BC risk-reduction after RRSO in BRCA1/2 mutation carriers.
11 May Frequent Emergency Department Users More Likely To Die Or Be Admitted
MedicalResearch.com Interview with:
Dr. Brian Rowe, MD, MSc, CCFP(EM), FCCP
Professor, Department of Emergency Medicine
University of Alberta, Edmonton, Alberta, Canada
MedicalResearch: What is the background for this study?
Dr. Rowe: Frequent users are also called “familiar faces” or “heavy users” and they represent an important sub-group of patients in the emergency setting, with often complex needs that contribute to overcrowding and excess health care costs. The evidence suggests that frequent users account for up to one in 12 patients seeking emergency care, and for around one in four of all visits.
MedicalResearch: What are the main findings?
Dr. Rowe: Frequent users of emergency department care are more than twice as likely to die, be admitted to hospital, or require other outpatient treatment as infrequent users, concludes an analysis of the available evidence, published in Emergency Medicine Journal.
These conclusions are based on a thorough search of seven electronic databases of relevant research relating to the frequency and outcomes of emergency department use by adults. Out of a total of more than 4000 potential studies, 31 relevant research reports published between 1990 and 2013 were included in the final analysis. Frequent users were variably defined as visiting emergency care departments from four or more times up to 20 times a year.
Among the seven studies looking at deaths, the analysis showed that frequent attenders at emergency care departments were more than twice as likely to die as those who rarely sought emergency care. Most of the studies included hospital admission as an outcome, and these showed that frequent users were around 2.5 times as likely to be admitted as infrequent users. Ten studies looked at use of other hospital outpatient care, and these showed that frequent users were more than 2.5 times as likely to require at least one outpatient clinic after their visit to the emergency care department.
11 May Viagra Derivatives May Block Malaria Transmission
MedicalResearch.com Interview with: Dr. Gordon Langsley Laboratoire de Biologie Cellulaire Comparative des Apicomplexes, Institut Cochin, INSERM U1016, CNRS UMR 8104, Faculté de Medecine Université Paris Descartes, Paris Medical Research: What is the background for this study? What are the main findings? Response: We have been studying the role of cAMP-dependent PKA signaling in Plasmodium falciparum-infected red blood cells for some time; see just a few examples: PMID: 25522250; PMID: 22626931; PMID: 18248092; PMID: 11559352 and we came to the conclusion that intra cellular cAMP levels regulate infected red blood cell deformability and adhesion to for example, brain endothelial cells.10 May Sleep Loss Impairs Decision Making
MedicalResearch.com Interview with:
Hans P.A. Van Dongen, Ph.D.
Director, Sleep and Performance Research Center
Research Professor, College of Medical Sciences
Washington State University Spokane, Spokane, WA
On behalf of the authors: Paul Whitney PhD, John Hinson PhD, Melinda Jackson PhD, Hans Van Dongen PhD
MedicalResearch: What is the background for this study? What are the main findings?
Research: Our main interest is in better understanding why people sometimes are able to manage perfectly well with sleep loss, while at other times sleep loss can have profoundly negative effects. We found that sleep deprivation reduces the effectiveness of signals used to tell when you are right or wrong, an effect we labeled feedback blunting.
Subjects in the study performed a decision making task that was simple but required feedback, i.e., a signal indicating the response was correct or incorrect, to perform correctly. We found that people who were sleep deprived were no longer able to use the feedback information to make correct responses. And when people had to adapt to unexpected changes in when to respond, sleep deprived people were completely unable to adapt to these changing circumstances.
The finding of feedback blunting in this study indicates that people who are sleep deprived not only have trouble sustaining attention to details in the environment (a well established effect of sleep loss), they also have trouble changing the focus of attention to deal with changing circumstances.
An interesting paradox in the research literature has been that people have been shown in many circumstances to perform complex tasks at a very high level while sleep deprived. Yet, we know from real-world experience that sleep deprived people can make catastrophic, life-threatening decisions that they would never have made if they were well rested. The current study is the first to shed light on this issue. It showed that sleep deprived people who get feedback, telling them that their actions are not effective, are less capable of changing their behavior.
The study is part of a line of research in which we are trying to identify how sleep loss changes specific components of cognition, and how these changes may lead to serious problems in everyday life activities. Being able to study and understand these effects of sleep deprivation under controlled conditions is an important step toward preventing human error under real world conditions.
10 May Variability of Biomarkers Used In Clinical Trials May Cloud Outcomes
MedicalResearch.com Interview with:
Alan H.B. Wu, PhD, DABCC
Professor Laboratory Medicine
Chief, Clinical Chemistry Laboratory
University of California San Francisco, CA
Medical Research: What is the background for this study? What are the main findings?
Response: Clinical trials are conducted for validation of novel biomarkers. There is considerable heterogeniety in the quality design and documentation of findings. This can have a major impact on the conclusions rendered.
10 May PREDIMED Study Demonstrates Heart Health Benefits of Mediterranean Diet
MedicalResearch.com Interview with:
Miguel Á. Martínez-González, MD, MPH, PhD
Department of Preventive Medicine & Public Health
School of Medicine, University of Navarra
Navarra, Spain
Medical Research: What are the main findings?
Response: The diet-heart hypothesis has been researched during decades. A common mistake was to assume that a high intake of all types of fat was detrimental for cardiovascular health and could cause heart attacks and strokes. Therefore a low-fat diet was proposed as the best way to prevent heart attacks and strokes. This was wrong.
Alternatively, the Mediterranean diet, rich in fat from natural vegetable sources (olive oil, tree nuts), was also considered a healthy dietary pattern.
However, most of the evidence to support these benefits of a fat-rich Mediterranean diet came from observational studies and no randomized clinical trial had ever assessed the Mediterranean diet in PRIMARY prevention (i.e. in initially healthy people)
09 May Emotional Reactivity May Be Genetically Predisposed
MedicalResearch.com Interview with:
Rebecca Todd Ph.D.
Assistant Professor University of British Columbia
Department of Psychology
Centre for Interactive Research on Sustainability
Vancouver, BC
Medical Research: What is the background for this study? What are the main findings?
Dr. Todd: This study brings together two lines of research. First, a couple of years ago my colleagues and I reported that in general people literally see emotional aspects of the world as more vivid - as if they burn more brightly on the eye - than mundane things. We call this effect emotionally enhanced vividness, or EEV. Here we wanted to look at how this phenomenon of emotionally enhanced vividness might differ between individuals.
Second, in another previous study we found that people who carry a very common variation in the ADRA2b gene, which influences levels of norepinephrine (a neuromodulator in the brain that is important to the stress response and for emotional influences on memory) were more likely to have their attention captured by emotionally relevant aspects of the world. We also found that how arousing they perceived an event to be at the time it happened predicted how well they remembered it better than for people who did not carry this variation. Here we continued to examine what is unique to this group of people by testing to see if they showed higher levels of the other phenomenon we had found, emotionally enhanced vividness, and what patterns of brain activation would play a role.
08 May Measures To Reduce Sugary Drinks Gains Public Acceptance
MedicalResearch.com Interview with:
Dr. Dragos Petrescu
Department of Public Health and Primary Care
Cambridge
Medical Research: What is the background for this study? What are the main findings?
Response: Consumption of sugar-sweetened beverages is a major contributor to obesity, particularly in children. Recent systematic reviews provide good evidence that reducing portion size reduces consumption. Similarly, evidence suggests that container shapes and product placement in supermarkets can influence consumption. The public acceptability of "nudging" -- altering properties such as the size, the shape, and location of sugar-sweetened beverages -- to improve public health is unknown. Here we compared the acceptability in UK and USA samples of government interventions to reduce consumption of sugar-sweetened beverages: three nudge interventions (limiting portion size, changing container shape, and changing shelf location) and two traditional interventions (increased taxation and an education campaign).
We found that for the majority of UK and USA samples, the education campaign and the three nudge interventions were acceptable, with education attracting most support. By contrast, only a minority of participants supported taxation.
08 May Obese Patients Face Stigma and Discrimination
MedicalResearch.com Interview with: Claudia Sikorski Dr. rer. med. Claudia Sikorski, Dipl.-Psych. Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) Institute of Social Medicine, Occupational Health and Public Health Universität Leipzig, Medizinische Fakultät Leipzig Medical Research: What is the background for this study? What are the main findings? Response: Obesity is a highly stigmatized condition. People with obesity are often regarded a lazy, slow and sloppy. One consequence of these negative attitudes may be discrimination, e.g. the unfair treatment of individuals with obesity. This study, conducted by Jenny Spahlholz, myself and colleagues reviews observational and experimental studies that investigated the occurrence and nature of discrimination in obesity.08 May Childhood Obesity Presents Opportunities and Challenges
MedicalResearch.com Interview with: Rebecca Jones, MSPH Nutrition and Health Sciences Program Graduate Division of Biological and Biomedical Sciences Emory University Medical Research: What is the background for this study? What are the main findings? Response: Obesity in children is associated with a wide range of conditions later in life including heart disease, cancer, and diabetes. Even prior to adulthood, children can be affected by a host of non-communicable diseases which are affected by weight status of the child. With an increase in children who are overweight or obese globally, Dr. Chan, Director-General of the World Health Organization, announced a new initiative to combat childhood obesity at the 2014 World Health Assembly. Within childhood obesity the pre-school (under age 5) years are a critical period for prevention due the association of adiposity rebound and obesity in later years as well as the early establishment of taste preferences and attitudes around healthy eating habits. Recent evaluation of incident obesity in the United States has demonstrated a component of the course to obesity is already established by the age of five years. Our main finding is the necessity for better surveillance and comparability of weight status, particularly overweight and obesity, in children under five across countries in the European region. 60% of countries within the region have some form of published data on this particular population however they vary based on level of national representation, cut-off criteria, age and gender. All these different factors can significantly change the prevalence estimates making it very difficult to ascertain the full nature of the problem. Based on the data which was available the European Region has reason for concern about overweight and obesity in young children.08 May Comprehensive Stroke Centers Save Lives In Patients With Hemorrhagic Stroke
MedicalResearch.com Interview with:
James S McKinney, MD, FAHA
Assistant Professor of Neurology
Rutgers-Robert Wood Johnson Medical School
Medical Director, RWJUH Comprehensive Stroke Center
New Brunswick, NJ 08901
Medical Research: What is the background for this study? What are the main findings?
Dr. McKinney: The current study evaluated outcomes of patients admitted to New Jersey hospitals with hemorrhagic stroke, including intracerebral hemorrhage (bleeding into the brain) and subarachnoid hemorrhage (bleeding along the surface of the brain) between 1996 and 2012 using the Myocardial Infarction Data Acquisition System (MIDAS) administrative database. The New Jersey Department of Health and Senior Services designates certain hospitals as comprehensive stroke centers (CSCs). We found that patients admitted to comprehensive stroke centers with hemorrhagic stroke were less likely to die than those admitted to other hospital types. This was particularly true for those patients admitted with subarachnoid hemorrhage, which is usually caused by a ruptured aneurysm.
08 May Statin Users Have Increased Risk Of Diabetes and Obesity
MedicalResearch.com Interview with:
Ishak Mansi, MD
Staff Internist, VA North Texas Health System.
Professor in Department of Medicine &
Department of Clinical Sciences, Division of Outcomes and Health services Research, University of Texas Southwestern, Dallas, TX
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Mansi: Statin use is associated with increased incidence of diabetes, and possibly increased body weight, and less exercise capacity. Data on the long-term effects of these associations in healthy adults are very limited. Additionally, the effects of these associations on diabetic complications have not been adequately studied.
Dr. Mansi at VA North Texas Health System, Dallas and Professor of Medicine and Clinical Sciences at the University of Texas Southwestern, Dallas, TX and his colleagues found that among generally healthy individuals, statin-users in comparison to non-users had a higher odds of being diagnosed with new onset diabetes, diabetes with complications, and overweight/obesity.
The researchers examined the records of tens of thousands of Tricare beneficiaries, during the period from 10/1/2003 to 3/1/2012. After excluding patients who had at baseline a preexisting cardiovascular diseases or severe chronic diseases that may be life-limiting (including diabetes mellitus), they identified a cohort of 25,970 patients as “healthy cohort”. They, further, matched 3,351 statins-users and 3,351 nonusers on several baseline characteristics to ensure comparability.
There are 3 main important findings for our study:
- Statin use was associated with significantly higher risk of new onset diabetes even in a very healthy population. Whereas the risk of diabetes with statins is known, it was thought that this may be due to the overall multiple risks of statin-users (that caused them to receive statins as a therapy).
- Statin use was associated with very high risk of diabetes complications in this healthy population: this was never shown before.
- Statin use is associated with higher risk of obesity: this also is widely unknown. However, few studies have noted this (one study using patient survey noted this, another study using Mendelian randomization showed it, and post-hoc analysis of a clinical trial showed that statin user gained more weight). Our study, which used a different methodology (retrospective cohort study) add another piece of evidence. Obesity is at endemic level in the US and treatment options are limited.
08 May Orthopedic Patients and Their Families At Risk For Opioid Abuse
MedicalResearch.com Interview with:
Hassan R. Mir, MD, MBA
Associate professor of Orthopaedics and Rehabilitation
Vanderbilt Orthopaedic Institute and
and
Dr. Brent J. Morris, M.D.
Shoulder and Elbow Surgery Fellowship
Texas Orthopaedic Hospital University of Texas Houston Health Science Center,
Houston, Texas
Medical Research: What is the background for this study? What are the main findings?
Dr. Mir: The past few decades have seen an alarming rise in opioid use in the United States, and the negative consequences are dramatically increasing. The US represents less than 5% of the world's population, yet consumes 80% of the global opioid supply. Management of pain is an important part of patient care, however, the increased usage of opioids for the treatment of pain has led to several unanticipated aftereffects for individual patients and for society at large.
Orthopaedic surgeons are the third highest prescribers of opioid prescriptions among physicians in the United States. Orthopaedic patients can experience a tremendous amount of pain with acute injuries and chronic conditions, and the treatment plan may involve opioid prescriptions for relief of discomfort. A significant number of orthopaedic patients and their families are at risk for repercussions from opioid use. We must work together to decrease the use of opioids for musculoskeletal pain.
Clinicians should aim to control pain and improve patient satisfaction while avoiding overprescribing opioids. A comprehensive strategy of risk assessment is needed to identify patients who may be at risk for opioid abuse. Objective measures including patient history, recognition of aberrant behavior, urine drug testing, state prescription drug–monitoring programs, and opioid risk-assessment screening tools may be necessary in select cases.
08 May Hospitals Vary In Treatment Of 22-24 Week Preterm Infants
MedicalResearch.com Interview with: Mr. Matthew A. Rysavy, B.S and Edward Bell, MD Department of Pediatrics, University of Iowa Iowa City, IA Medical Research: What is the background for this study? What are the main findings? Response: We were interested in understanding reasons for differences in outcomes among extremely preterm infants among hospitals. This has been shown in many studies. We found that differences among hospitals in whether treatment was initiated for infants born at very early gestations (22, 23, 24 weeks' gestation) accounted for a lot of the variation in hospital-level outcomes at these gestational ages.07 May Deficient Calcium Channels Weaken Immune Response To Chronic Infections
MedicalResearch.com Interview
Dr. Ludovic Desvignes PhD.
Assistant Professor, Departments of Medicine and Pathology
NYU Langone Medical Center
MedicalResearch: What is the background for this study?
Dr. Desvignes: This study is the result of a collaboration at NYU Langone Medical Center, between the laboratories of Dr. Stefan Feske and Dr. Joel Ernst, my mentor. Dr. Feske and colleagues had developed a mouse model of rare, inherited mutations he had identified in infants. These mutations occur in the genes for STIM1 and ORAI1, which are crucial for calcium flux in cells of the immune system. The young patients affected by these mutations suffer from severe, recurrent and chronic infections that often cause death before their first birthday. In particular, some of these patients cannot control infection with BCG, which is a normally innocuous strain of mycobacteria administered to protect against tuberculosis (TB). TB is a chronic infection and one of the leading causes of infection-related death worldwide. Going into this study, Dr. Feske and colleagues knew that without functional calcium channels, immune cells do not function properly. However, they did not fully understand how these channels contribute to immune responses to infectious pathogens in a living organism and in particular, for pathogens that cause chronic infections such as TB. This is why Dr. Ernst and I collaborated with Dr. Feske and provided him with our clinical and research expertise in TB.
MedicalResearch: What are the main findings?
Dr. Desvignes: Dr. Feske’s mice are genetically engineered to lack STIM1 in a certain type of immune cells, known as T cells or T lymphocytes. We infected these mice with Mycobacterium tuberculosis, the bacterium causing TB. Mycobacterium tuberculosis causes chronic infection by manipulating the immune system even in healthy people. The first very surprising result of our study was that mice lacking calcium flux in T cells handled acute TB fairly well. Only during the chronic phase of infection did they become unable to control mycobacterial growth and developed a strong inflammation in their lungs, which was due to an infiltration by different types of immune cells, including T cells. We discovered that the accumulation of STIM1-deficient T cells in the lungs resulted from the cells’ inability to die, which is a normal mechanism to limit an immune response and prevent excessive inflammation.
Another immune control mechanism that failed in the absence of STIM1 is mediated by a subset of T cells called induced regulatory T cells, or iTreg cells. These cells are essential to prevent normal immune responses from going “overboard” by suppressing the functions of other immune cells, including T cells. We found that calcium signals are required for the development of iTreg cells and that their numbers were strongly reduced in the lungs of infected STIM1-deficient mice. We therefore think that the lack of iTreg cells in the absence of STIM1 contributes to the severe lung inflammation in chronic TB.
The third finding that really surprised us was that T cells accumulating in the lungs of STIM1-deficient mice produced large amounts of a protein called interferon gamma. While interferon gamma is required to control Mycobacterium tuberculosis, it is also a very potent promoter of inflammation and too much of it can lead to tissue damage. Dr. Feske and colleagues had previously observed that calcium fluxes promote the production of interferon gamma in T cells cultured in vitro and we expected the STIM1-deficient T cells to be defective in the production of that protein. During chronic TB, however, calcium signaling turned out to be not only dispensable for the production of interferon gamma by T cells but it was actually required to limit its production and thus, to control inflammation.