Author Interviews, Baylor College of Medicine Houston, Breast Cancer / 10.02.2015

Dr. Xiang (Shawn) Zhang PhD Assistant Professor Department of Molecular and Cellular Biology Lester and Sue Smith Breast Center Baylor College of Medicine Houston, TexasMedicalResearch.com Interview with: Dr. Xiang (Shawn) Zhang PhD Assistant Professor Department of Molecular and Cellular Biology Lester and Sue Smith Breast Center Baylor College of Medicine Houston, Texas   Medical Research: What is the background for this study? What are the main findings? Response: Bone metastases present a major clinical problem for oncologists. They are very painful and unpleasant due to the ability of metastatic cells to dissolve bones, and if they spread to the spine or vertebrate bone they  the spinal cord compression could cause paralysis. There is a gap in our knowledge about bone metastasis in breast cancer. We know a lot about when they are fully established and already dissolving the bone, but little about what happens early on, right after the cancer cells get there but before they start the bone-dissolving process. In the study, we revealed that in the early stages, when there are only a few cancer cells, these cells tend to locate themselves in a microenvironment that is enriched in bone making cells called osteoblasts whose normal job is to help make new bones. The cancer cells appear to be surrounded by these bone-making cells before they acquire the ability to dissolve bones. We also uncovered the pathway that gets activated when the cancer cells lodge into the bone-making cells, and helps them progress to more malignant metastases. The action is mediated by a class of proteins that helps bind the cancer cells to the bone tissue called heterotypic adherens junctions (hAJs) involving the adherens proteins E-cadherin (cancer-derived) and N-cadherin (bone-promoting). This then activates the mTOR pathway in cancer cells, which drives the progression from single cells to metastases.
Author Interviews, CDC, Vaccine Studies / 10.02.2015

MedicalResearch.com Interview with: Tom Shimabukuro, MD, MPH, MBA Captain, U.S. Public Health Service Deputy Director Immunization Safety Office Centers for Disease Control and Prevention (CDC) Medical Research: What is the background for this study? What are the main findings? Response: CDC conducted a study looking at reports of adverse events (possible side effects) following measles, mumps, and rubella (MMR) vaccination in adults. Researchers reviewed the Vaccine Adverse Event Reporting System (VAERS) database for U.S. reports of adults aged 19 years and older who received MMR vaccine from January 1, 2003 to July 31, 2013. During this period, VAERS received 3,175 U.S. reports after MMR vaccine in adults. The most common signs and symptoms for all reports were fever (19%), rash (17%), pain (13%), and joint pain (13%). The study included adults only, a population for which there is limited safety data for this vaccine. This study further supports the MMR vaccine’s safety.  Researchers did not find any new or unexpected safety concerns.
Author Interviews, Exercise - Fitness, Gender Differences, Primary Care / 10.02.2015

Molly B. Conroy MD, MPH Assistant Professor of Medicine, Epidemiology, and Clinical and Translational Science University of Pittsburgh, Pittsburgh, PA,MedicalResearch.com Interview with: Molly B. Conroy MD, MPH Assistant Professor of Medicine, Epidemiology, and Clinical and Translational Science University of Pittsburgh, Pittsburgh, PA, Medical Research: What is the background for this study? What are the main findings? Response: The background for the study is the fact that middle-aged women are at high risk for being physically inactive, which puts them at higher risk for heart disease, cancer, and other chronic health problems. We compared an interventionist-led physical activity and weight loss program delivered in coordination with primary care to a booklet that women were asked to use to exercise by themselves at home. We found that women who received the interventionist-led program had significantly greater increases in physical activity at 3 months, compared to women who received booklet. At 12 months, women who received the interventionist-led program were still more active than they were before starting the program, although the difference between the 2 groups was no longer significant.
Author Interviews, Blood Pressure - Hypertension, Diabetes, JAMA / 10.02.2015

Prof. KAZEM RAHIMI | DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford Deputy Director, The George Institute for Global Health James Martin Fellow in Healthcare Innovation, Oxford Martin School Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School | University of Oxford Oxford United KingdomMedicalResearch.com Interview with: Prof. Kazem Rahimi  DM MSc FESC Associate Professor of Cardiovascular Medicine, University of Oxford ;Deputy Director, The George Institute for Global Health; James Martin Fellow in Healthcare Innovation, Oxford Martin School; Honorary Consultant Cardiologist, Oxford University Hospitals NHS Trust The George Institute for Global Health Oxford Martin School United Kingdom Medical Research: What is the background for this study? What are the main findings? Dr. Rahimi: Lowering blood pressure (BP) in individuals with diabetes is an area of current controversy. Although it is widely accepted that lowering blood pressure in people with diabetes and elevated blood pressure will reduce the risk of heart and circulatory problems, it is less certain whether diabetics whose blood pressure is not very high should be treated with blood pressure lowering drugs, and how far their blood pressure should be reduced. It is also less well known how blood pressure lowering affects a range of other potential health complications for diabetes patients, such as diabetic eye disease. We found that each 10-mm Hg lower systolic blood pressure led to a lower risk of mortality, cardiovascular disease events, coronary heart disease events, stroke, albuminuria (the presence of excessive protein in the urine), and retinopathy (loss of vision related to diabetes). Although proportional effects of blood pressure lowering treatment for most outcomes studied were diminished below a systolic BP level of 140 mm Hg, data indicated that further reduction below 140 mm Hg led to a lower risk of stroke, retinopathy, and albuminuria, potentially leading to net benefits for many individuals at high risk for those outcomes.
Author Interviews, MD Anderson / 10.02.2015

Dihua Yu, M.D., Ph.D. Hubert L. & Olive Stringer Distinguished Chair in Basic Science Professor and Deputy Chair Department of Molecular and Cellular Oncology Co-Director, Center of Biological Pathways The Univ. Texas MD Anderson Cancer Center Houston, TX 77030MedicalResearch.com Interview with: Dihua Yu, M.D., Ph.D. Hubert L. & Olive Stringer Distinguished Chair in Basic Science Professor and Deputy Chair Department of Molecular and Cellular Oncology Co-Director, Center of Biological Pathways The Univ. Texas MD Anderson Cancer Center Houston, TX 77030 Medical Research: What is the background for this study? Dr. Yu: Transforming growth factor β (TGF-β) functions as a tumor suppressor in premalignant cells but may also function as a metastasis promoter in cancer cells. This study aimed to understand how the growth factor makes this switch between tumor suppressor to tumor promoter. Medical Research: What are the main findings? Dr. Yu: We reported that 14-3-3ζ overexpression (14-3-3ζ+++) can switch TGF-β’s function from tumor suppressor to metastasis promoter by changing Smad partners. Specifically, 14-3-3ζ+++ led to destabilization of p53, a Smad determinant in pre-malignant cells, thus disrupting p53/Smad complex, and consequently inhibiting TGF-β-induced p21 expression and cytostatic function in non-malignant human mammary epithelial cells (HMECs). On the contrary, 14-3-3ζ+++ stabilized Gli2, a Smad partner in cancer cells, and Gli2 complexed with Smads to promote TGF-β-induced parathyroid hormone-related protein (PTHrP) expression, which enhanced breast cancer bone metastasis. Remarkably, both transcriptomic analyses and clinical pathology data indicated that 14-3-3ζ+++ is associated with the loss of TGF-β’s tumor suppressor function and the gain of its metastasis promoter function by changing contextual partners of Smads. Taken together, we have identified 14-3-3ζ as a novel molecular switch of TGF-β’s function by altering Smad partners from p53 in pre-malignant cells to Gli2 in cancer cells. The study provided important answers to the long-standing questions of how and when TGF-β switches its functional roles from a tumor suppressor to a metastasis promoter. The findings established a scientific base for a new strategy of selectively targeting TGF-β signaling in cancer by inhibiting the cancer-specific Smad partner without blocking TGF-β’s tumor suppressor function in normal tissues.
Author Interviews, Mental Health Research, Occupational Health / 10.02.2015

Prof.dr. Judith K. Sluiter Principal Investigator Manager KMKA: Kenniscentrum Medische Keuringen in Arbeid Nationaal secretaris voor ICOH (International Commission on Occupational Health) Coronel Instituut voor Arbeid en Gezondheid, Academisch Medisch Centrum / UvA Meibergdreef AmsterdamMedicalResearch.com Interview with: Prof.dr. Judith K. Sluiter Principal Investigator Manager KMKA: Kenniscentrum Medische Keuringen in Arbeid Nationaal secretaris voor ICOH (International Commission on Occupational Health) Coronel Instituut voor Arbeid en Gezondheid, Academisch Medisch Centrum / UvA Meibergdreef Amsterdam Medical Research: What is the background for this study? Prof. Sluiter: Professional footballers contain a group of employees working in a job with specific job demands. The occupational guidance and prevention of decreased work functioning of workers in these kinds of jobs should receive more attention. The mental health of professional footballers receive less attention compared to their physical health. We studied the prevalence of self-reported mental health problems and psychosocial difficulties in a group of current and former professional footballers, and we explored the association between having had psychosocial stressors and the health conditions under study. Medical Research: What are the main findings? Response: The response rate was 29% with available data from 253 footballers. In current players, the prevalence of mental health complaints ranged from 5% (burnout) to 26% (anxiety/depression). In former players, the prevalence ranged from 16% (burnout) to 39% (anxiety/depression). A small percentage of players had low self-esteem (3-5%). One quarter to two-fifth of the players showed adverse nutrition behaviour. Small but significant association between experiencing lower social support (OR=1.1) and having had recent life events (OR=1.4-1.6) and mental health complaints were found in current players. Having had severe injuries was associated with better nutrition behavior. In former players, having had life events showed a preventive effect on smoking (OR=0.4) and having had previous surgery was significantly associated with current smoking behavior (OR=1.9).
Author Interviews, Pain Research / 10.02.2015

MedicalResearch.com Interview with: A/Prof Manuela Ferreira PhD Senior Research Fellow, Musculoskeletal Division Associate Professor, Sydney Medical School The George Institute for Global Health Sydney Australia MedicalResearch: What is the background for this study? Dr. Ferreira: Our study was set up to look at the common triggers for sudden and moderate to severe episodes of back pain. It included 1,000 participants with this condition. Participants were interviewed in the first week their pain episode occurred in and were asked to describe their physical and psychosocial activities in the 3 days preceding pain onset. MedicalResearch: What are the main findings? Dr. Ferreira: The results of the study have shown that sudden attacks of back pain are more likely to be triggered in the morning, between 8 am and 11 am. Being distracted while engaged in manual tasks, manual tasks performed in an awkward posture, or those involving objects not close to the body and lifting heavy loads were activities that most likely would trigger a new episode of back pain, even following very brief exposure (i.e. less than 2 hours). If you feel like this is you, you should visit a round rock chiropracter to aid progress!
Author Interviews, Mental Health Research, Nursing / 09.02.2015

Erin L. Kelly PhD Post Doctoral Scholar Health Services Research Center University of California, Los Angeles, CaliforniaMedicalResearch.com Interview with: Erin L. Kelly PhD Post Doctoral Scholar Health Services Research Center University of California, Los Angeles, California MedicalResearch: What is the background for this study? What are the main findings? Dr. Kelly: Mental health facilities can be hazardous workplaces. Nationally, compared to their counterparts in other healthcare settings, mental health workers are at the highest risk for patient assaults. Many studies have focused on predictors for assault such as gender, years of experience, or the position that staff hold in the hospital, which can account for a small amount of violence. However, psychiatric care is largely about relationships. Our study examined how conflicts with patients and coworkers, and how people react to conflict, influences their risk of assault. In our study, 70% of staff at a large public mental hospital were assaulted in a single year, which is closer to the lifetime assault rate for mental health workers. We also found that the likelihood of assault is predicted by conflicts when we also include stress reactions to conflict as a moderator. We found that workers who reported being less reactive to conflict but experienced a great deal of conflict, with staff or patients, were at the highest risk of assault. This could mean that people who aren't afraid of conflict with patients are more likely to jump in with agitated patients or that people who are insensitive to conflict are missing important social cues and being assaulted more often. However, despite the similarity in the relationships of staff conflict and patient conflict with assault risk, it’s possible that the direction of the relationship between staff conflict and assault may be different. For example, mental health staff who have a lot of conflict with their co-workers may be isolated and therefore a target for assault by patients.
Author Interviews, Infections, Technology / 09.02.2015

[caption id="attachment_11496" align="alignleft" width="200"]Smartphone dongles performed a point-of-care HIV and syphilis test from finger prick whole blood in 15 minutes, operated by health care workers trained on a software app. Credit: Samiksha Nayak, Columbia Engineering Smartphone dongles performed a point-of-care HIV and syphilis test from finger prick whole blood in 15 minutes, operated by health care workers trained on a software app. Credit: Samiksha Nayak, Columbia Engineering[/caption] MedicalResearch.com Interview with: Tassaneewan Laksanasopin PhD Candidate Molecular and Microscale Bioengineering Lab Columbia University Medical Research: What is the background for this study? What are the main findings? Response: We miniaturized and integrated all components needed for blood test (similar to ELISA) to be run on a smartphone accessory for point-of-care testing of infectious diseases.  The device simultaneously detects three infectious disease markers for HIV, treponemal syphilis and nontreponemal syphilis from a finger prick of blood in just 15 minutes.  In a blinded experiment in three health clinics in Rwanda, local health care workers obtained diagnostic results from 96 patients enrolled in prevention of mother-to-child transmission and voluntary counseling programs.  The test performance from our triplexed test was 92-100% sensitivity and 79-92% specificity compared to the gold standard of lab-based HIV ELISA, Treponema pallidum haemagglutination and rapid plasma reagin.  Importantly, patient preference for the dongle was 97% compared to lab-based tests, with most pointing to the convenience of obtaining quick results with a single finger prick.  This work suggests coupling microfluidics with recent advances in consumer electronics can make certain lab-based diagnostics accessible to almost any population with access to smartphones.
Author Interviews, Genetic Research, JAMA, Personalized Medicine / 09.02.2015

Andres Moreno De Luca, MD Investigator and Resident Physician Autism & Developmental Medicine Institute Department of Radiology Geisinger Health System Danville, PA 17822MedicalResearch.com Interview with: Andres Moreno De Luca, MD Investigator and Resident Physician Autism & Developmental Medicine Institute Department of Radiology Geisinger Health System Danville, PA 17822   Medical Research: What is the background for this study? What are the main findings? Response: The main finding of our study is that family background contributes to the variability in cognitive, behavioral, and motor performance seen in children with 16p11.2 deletions, and perhaps other genetic syndromes, and this may be attributed in part to genetic background effects. In the general population the best predictor of a child’s outcomes in traits such as cognitive ability, height, BMI, etc. is the biparental mean performance in such domains and this is due in part to genetic background. For example, if a child’s parents have IQ scores of 130 and 110, it is expected that the child will have an IQ within 2 standard deviations of 120 (bi-parental mean). However, when studying individuals with genetic conditions, most researchers tend to overlook the influence of familial/genetic background on the affected child’s outcomes and commonly attribute the manifestations (or lack thereof) to the genetic mutation alone. This creates confusion when studying children with neurodevelopmental disorders, such as autism, which show significant clinical variability, as some children with a specific genetic mutation (e.g. deletion 16p11.2) may have intellectual disability without autism, while other children with the same mutation may have autism without intellectual disability. Based on these observations, some researchers have argued that deletion 16p11.2 is incompletely penetrant. However, our study showed that the 16p11.2 deletion has a detrimental effect on cognitive and behavioral performance for all children, but the clinical status (affected vs. unaffected) and ultimate performance level is influenced by the parental performance.
Author Interviews, JAMA, Surgical Research, Weight Research / 09.02.2015

MedicalResearch.com Interview with: Torsten Olbers MD, PhD Assistant Professor of Surgery Sahlgrenska University Hospital Gothenburg, Sweden Medical Research: What is the background for this study? What are the main findings? Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th.
Author Interviews, Mental Health Research, UCSF / 09.02.2015

Ezequiel Morsella, Ph.D. Associate Professor of Neuroscience Department of Psychology San Francisco State University Assistant Adjunct Professor Department of Neurology University of California, San Francisco Boardmember, Scientific Advisory Board Institute of Cognitive Neurology (INECO), Buenos AiresMedicalResearch.com Interview with: Ezequiel Morsella, Ph.D. Associate Professor of Neuroscience Department of Psychology San Francisco State University Assistant Adjunct Professor Department of Neurology University of California, San Francisco Boardmember, Scientific Advisory Board Institute of Cognitive Neurology (INECO), Buenos Aires Medical Research: What is the background for this study? What are the main findings? Dr. Morsella: Previous studies have demonstrated that, under certain experimental conditions, conscious processes in the brain can function in a way that resembles reflexes.  In past research, a single ‘high-level’ thought (e.g., the name of a visually-presented object) was triggered involuntarily by external stimuli. The current research is the first to trigger, not one, but two high-level unintentional conscious thoughts. In this experiment, participants were presented with an object (e.g., the picture of a star) and instructed to not subvocalize (i.e., name in one’s head but not aloud) the name of the object nor count the number of letters comprising the name of the object.  On many trials, participants experienced both cognitions (e.g., “STAR” and “4”), even though these thoughts were against the intentions of the participant. Thus, this is the first demonstration of external control of two thoughts in the stream of consciousness. This research is based in part on the pioneering investigations of Wegner, of Gollwitzer, and of Ach.
Author Interviews, Heart Disease / 09.02.2015

Prof. Ran Kornowski, M.D, FACC, FESC on behalf of the coauthors Chairman - Division of Cardiology, Rabin Medical Center, Petah-Tikva, IsraelMedicalResearch.com Interview with: Prof. Ran Kornowski, M.D, FACC, FESC on behalf of the coauthors Chairman - Division of Cardiology, Rabin Medical Center, Petah-Tikva, Israel Medical Research: What is the background for this study? Prof. Kornowski:  Over the years, the PCI procedure went-through many progresses. Among those are some angioplasty techniques, generalize use of stents and drug eluting stents, and adjuvant novel antithrombotic therapy. Unmistakably, these were associated with an overall improved PCI outcome. As many of the data on PCIs’ adverse outcomes predictors come from predates studies, we sought to update this matter. Medical Research: What are the main findings? Prof. Kornowski: This study confirms the influence of advanced age, diabetes-mellitus and  urgent settings (i.e. acute coronary syndromes) on PCI long term outcome. However, we found that their effect extent is modest while supplementary predictors such as anemia (even mild), chronic kidney injury and echocardiographic findings of left ventricular dysfunction have a greater effect on contemporary PCI prognosis.
Aging, Author Interviews, Memory, Nature, Nutrition / 09.02.2015

Ashok K. Shetty, Ph.D. Professor and Director of Neurosciences Institute for Regenerative Medicine and Department of Molecular and Cellular Medicine
Texas A&M Health Science Center College of Medicine, Temple, TX
Research Career Scientist, Central Texas Veterans Health Care System (CTVHCS), Temple, TXMedicalResearch.com Interview with: Ashok K. Shetty, Ph.D. Professor and Director of Neurosciences Institute for Regenerative Medicine and Department of Molecular and Cellular Medicine
Texas A&M Health Science Center College of Medicine, Temple, TX
Research Career Scientist, Central Texas Veterans Health Care System (CTVHCS), Temple, TX Medical Research: What is the background for this study? Prof. Shetty: Hippocampus is a region in the brain important for maintaining functions such as learning, memory and mood. However, this region is highly vulnerable to aging and brain insults. Previous research has shown that diminished function in the dentate gyrus region of the hippocampus is one of the key reasons for memory impairments seen in old age. Dentate gyrus is also one of the few regions in the brain where neural stem cells generate new neurons on a daily basis, also referred to as "adult neurogenesis". Studies have suggested that a significant fraction of newly born neurons mature, get incorporated into the existing hippocampus circuitry and contribute to learning, formation of new memories, and normal mood. However, with aging, the dentate gyrus shows decreased function with some conspicuous structural changes, which include reduced production of new neurons, diminished microvasculature implying reduced blood flow, and occurrence of hypertrophy of astrocytes and activated microglia, signs of chronic low-level inflammation. Because alterations such as reduced neurogenesis, decreased blood flow and brain inflammation can contribute to memory and mood impairments, the idea that drugs that are efficacious for mitigating these changes may preserve memory and mood function in old age has emerged. Such drugs may be prescribed to the aging population if they are efficacious for maintaining normal cognitive and mood function in old age with no or minimal side effects. Medical Research: What is the rationale for choosing resveratrol for preventing age-related memory dysfunction in this study? Prof. Shetty:  Administration of resveratrol, a naturally occurring polyphenol found in the skin of red grapes, red wine, peanuts and some berries, appeared suitable for counteracting age-related detrimental changes in the hippocampus. This is because, previous studies have shown that resveratrol has ability to promote the formation of new capillaries (through pro-angiogenic effects) and to suppress oxidative stress and inflammation (via antioxidant and antiinflammatory effects) with no adverse side effects. Other studies have also reported that resveratrol can mediate extension of the life span and delayed onset of age related diseases. More importantly, a recent human study suggested that a reasonably lower dose of resveratrol intake for 26 weeks is good enough to improve memory performance as well as hippocampus functional connectivity in 23 healthy overweight older individuals (Witte et al., J. Neurosci., 34: 7862-7870, 2014).
AHA Journals, Author Interviews, Heart Disease, Lipids / 09.02.2015

Ann Marie Navar-Boggan, MD PhD Fellow, Cardiovascular Disease Duke University School of Medicine MedicalResearch.com Interview with: Ann Marie Navar-Boggan, MD PhD Fellow, Cardiovascular Disease Duke University School of Medicine Medical Research: What is the background for this study? What are the main findings? Response: In this study of adults from the Framingham Offspring Study, we evaluated the impact of prolonged exposure to elevated cholesterol in early adulthood and future risk of coronary heart disease. In adults aged 55, the duration of time a person has been exposed to a non-HDL of >=160 mg/dL was associated with increased risk of coronary heart disease, and that risk was above and beyond the risk conferred by lipid levels at age 55. Every 10 years spent with a non-HDL of 160 or above was associated with a 39% increased future risk of coronary heart disease. We also looked at the association between prior average blood cholesterol between the age of 35 and 55, and found that every 10 mg/dL increase in prior average cholesterol above 125 mg/dL was associated with a 33% increased risk of coronary heart disease. These findings were particularly notable because the vast majority of adults with prolonged exposure to hyperlipidemia would not have been identified by the guidelines for statin therapy.​
Annals Internal Medicine, Author Interviews, End of Life Care / 07.02.2015

Adam E. Singer, MPhil, Pardee RAND Graduate School, RAND Corporation Santa Monica, CAMedicalResearch.com Interview with: Adam E. Singer, MPhil Pardee RAND Graduate School, RAND Corporation Santa Monica, CA MedicalResearch: What is the background for this study? What are the main findings? Response: In 1997, the Institute of Medicine (IOM) released a seminal report on the state of end-of-life care in the US that called for major changes in the organization and delivery of end-of-life care. Many of the IOM’s indictments have ostensibly been addressed since that time through the expansion of palliative care and hospice, along with a greater focus on symptom management in both policy and practice. This study was designed to ask whether end-of-life symptoms have become less prevalent from 1998 to 2010 for the population as a whole and also for subgroups that died suddenly or had cancer, congestive heart failure (CHF), chronic lung disease, or frailty. The study found that many alarming symptoms were common in the last year of life and affected more people from 1998 to 2010. For example, in the whole population, pain affected 54% in 1998 and 61% in 2010 (a 12% increase). Depression affected 45% in 1998 and 57% in 2010 (a 27% increase). Periodic confusion affected 41% in 1998 and 54% in 2010 (a 31% increase). Depression and periodic confusion also became more prevalent in subgroups with CHF and/or chronic lung disease and frailty. In addition, nearly all other symptoms in the whole population and in each of the subgroups trended toward increases in prevalence from 1998 to 2010, although most of these trends did not reach statistical significance. The one exception is that there were no significant changes in the subgroup with cancer.
Author Interviews, CDC, OBGYNE, Weight Research / 07.02.2015

Jonetta L. Johnson, PhD, MPH Epidemiologist Division of Reproductive Health, CDC. MedicalResearch.com Interview with: Jonetta L. Johnson, PhD, MPH Epidemiologist Division of Reproductive Health, CDC. Medical Research: What is the background for this study? Dr. Johnson: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. Women who gain below or above Institute of Medicine (IOM) recommendations are more likely to experience maternal complications and negative infant birth outcomes. Realizing the importance of  gestational weight gain to maternal and infant health, the IOM established recommendations for  gestational weight gain based on a woman’s prepregnancy body mass index (BMI) in 1990 and updated them in 2009. Trends in GWG are particularly of interest since prepregnancy BMI has increased over time in the U.S and little data was available on how  gestational weight gain has changed over time. Medical Research: What are the main findings? Dr. Johnson: Our findings show that from 2000-2009, the majority of women did not gain weight within IOM GWG recommendations and that women were more likely to gain outside recommendations in more recent years. In fact, from 2000–2009, there was a gradual decrease (1.0 percentage point every 2 years) in women gaining within IOM  gestational weight gain recommendations  and a gradual increase (0.8 percentage points every 2 years) in women gaining above IOM recommendations while the percentage of women gaining weight below IOM recommendations remained relatively constant.  Although there were slight differences in mean gestational weight gain by BMI group,  gestational weight gain was about 31 pounds on average. The decreasing percentage of women gaining within IOM recommendations during our study period may be influenced by increases in prepregnancy BMI during the same time period because women in higher BMI groups are recommended to gain less weight during pregnancy compared to women in lower BMI groups.  Thus, even with no change in gestational weight gain over time, an increase in the proportion of women who are obese could result in a decrease in the proportion of women gaining within gestational weight gain recommendations.
Author Interviews, Lancet, Lifestyle & Health / 07.02.2015

Dr Sandra L Jackson PhD Atlanta VA Medical Center, Decatur, GA, Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences Emory University, Atlanta, GA, USAMedicalResearch.com Interview with: Dr Sandra L Jackson PhD  Atlanta VA Medical Center, Decatur, GA, Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences Emory University, Atlanta, GA, USA Medical Research: What is the background for this study? What are the main findings? Dr. Jackson: Lifestyle change programs are aimed to improve health, yet little is known about their impact once translated into clinical settings. The Veterans Health Administration (VA) MOVE! program is the largest lifestyle change program in the U.S. Participation is a key challenge of the program, as only 13% of the eligible population participated. However, among patients who did not have diabetes at baseline, we found that MOVE! participation was associated with lower diabetes incidence.
AHRQ, Author Interviews / 07.02.2015

Steven C. Hill, PhD Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality Rockville, MD 2085MedicalResearch.com Interview with: Steven C. Hill, PhD Center for Financing, Access and Cost Trends Agency for Healthcare Research and Quality Rockville, MD 20850 MedicalResearch: What is the background for this study? Dr. Hill: The Affordable Care Act offers two major ways to extend health coverage to more Americans: through expanding state Medicaid programs and through the Marketplace. States can expand Medicaid coverage to adults with family incomes at or below 138 percent of the federal poverty guidelines (approximately $16,242 for an individual and $33,465 for a family of four in 2015). At the time of the study, 23 states had not yet expanded their Medicaid programs. In those states, poor adults typically continue to have very limited access to Medicaid. However, adults with incomes at or above the poverty guidelines who lack access to affordable insurance elsewhere are eligible for premium tax credits in the Marketplace. If these low-income adults purchase silver plans, then they are also generally eligible for cost sharing reductions. MedicalResearch: What was the methodology for study? Dr. Hill: The study used data from then Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) to determine family out-of-pocket health care spending in 2005 – 2010 for uninsured, low-income adults who lived in the states that had not yet expanded Medicaid under the Affordable Care Act at the time of the study. The study focused on those who would have been eligible for Medicaid if their states expanded eligibility (income at or below 138 percent of poverty guideline), and whose incomes were high enough to be eligible for premium tax credits and cost sharing reductions through the Health Insurance Marketplace (at or above poverty guidelines). The study then compared those data with the following simulated scenarios for these adults: coverage in a Marketplace silver plan with financial assistance; and enrolling in expanded Medicaid.
Author Interviews, Social Issues / 07.02.2015

Hailey Winetrobe, MPH, CHES Project Manager NIDA Transitions to Housing Study School of Social Work University of Southern CaliforniaMedicalResearch.com Hailey Winetrobe, MPH, CHES Project Manager NIDA Transitions to Housing Study School of Social Work University of Southern California MedicalResearch: What is the background for this study? What are the main findings? Response: Homeless young adults are a very vulnerable population with high healthcare needs. However, because of their housing instability and very low income, many homeless young adults may not have health insurance and/or access to healthcare services. Prior research regarding this population’s health insurance coverage was mostly outdated. Additionally, with the implementation of the Affordable Care Act (ACA), homeless young adults may now qualify for health insurance coverage (i.e., if there is a relationship, by being a dependent on their parent’s health insurance until 26 years old; and via Medicaid expansion in states choosing to expand). As such, this study aimed to update homeless young adults’ rates of health insurance coverage prior to the full implementation of the ACA (i.e., before Medicaid expansion) and to determine if there was an association between insurance and use of healthcare services. We found that 70% of homeless young adults did not have health insurance in the prior year. Of those with health insurance, 46% reported coverage through their parents, and 34% through Medicaid (not mutually exclusive). Over half (52%) of the sample received healthcare in the prior year. Furthermore, in a multivariable logistic regression model controlling for demographic characteristics, homeless young adults with health insurance, compared to their peers who did not have health insurance, had 11 times the odds of receiving healthcare in the prior year.
Asthma, Author Interviews, NIH, OBGYNE / 07.02.2015

Pauline Mendola, PhD, Investigator Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH Rockville, MD 20852MedicalResearch.com Interview with: Pauline Mendola, PhD, Investigator Epidemiology Branch Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH Rockville, MD 20852 Medical Research: What is the background for this study? What are the main findings? Dr. Mendola: Asthma is the most common chronic disease in pregnancy and both asthma and maternal race/ethnicity are associated with adverse pregnancy outcomes. Since the prevalence of asthma also varies by race/ethnicity, we wanted to assess whether asthma was an important contributor to racial/ethnic disparities in pregnancy outcomes. We examined the joint impact of maternal race/ethnicity and asthma status on the risk of obstetric and neonatal outcomes. In general, maternal asthma did not impact the risk of obstetric and neonatal complications within racial/ethnic groups. However, compared to mothers of the same race/ethnicity without asthma, White and Hispanic asthmatic mothers were more likely to have infants born small-for gestational age or admitted to the NICU. White women with asthma were also at increased risk of preeclampsia and maternal hemorrhage and Hispanic mothers with asthma were more likely to have infants with apnea. Despite their increased risk of maternal asthma and neonatal and obstetric complications, maternal asthma did not impact the risk of complications among Black women or their infants.
Author Interviews, Brigham & Women's - Harvard, PNAS, Sleep Disorders / 06.02.2015

Christa Van Dort PhD Department of Anesthesia, Critical Care, and Pain Medicine, Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts General Hospital, Harvard Medical School Boston, MA, 02114MedicalResearch.com Interview with: Christa Van Dort PhD Department of Anesthesia, Critical Care, and Pain Medicine, Department of Brain and Cognitive Sciences, Picower Institute for Learning and Memory, Massachusetts General Hospital, Harvard Medical School Boston, MA, 02114 Medical Research: What is the background for this study? What are the main findings? Dr. Van Dort:  Sleep is crucial for survival and maintenance of health.  Inadequate sleep and sleep disorders impair many brain and body functions such as executive function, the immune system and memory consolidation. The benefits of sleep are dependent on normal sleep physiology and patterns. Natural sleep is composed of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep alternating every 90 min in humans.  Each stage provides different benefits, for example deep NREM sleep is associated with feeling rested and REM sleep is important for learning. Current sleep aids do not effectively restore normal sleep physiology or timing and as a result do not fulfill the important functions of natural sleep.  To develop new strategies for reproducing natural sleep, we aimed to understand each component of sleep (NREM and REM sleep) individually and then in combination. Cholinergic neurons have been hypothesized to control REM sleep for many years but no one had been able to test this directly due to limited methodology. Optogenetics solved this problem by giving us the ability to activate selectively the cholinergic neurons in the pedunculopontine tegmentum (PPT) and laterodorsal tegmentum (LDT). The primary finding of this study was that cholinergic neurons in the PPT and LDT are sufficient to drive REM sleep from NREM sleep. These cholinergic neurons were important for initiation of REM sleep but not the duration of REM sleep. Understanding REM sleep control is an important first step in reproducing normal sleep patterns and by itself could enhance learning and memory.
Author Interviews, Brain Injury / 06.02.2015

Ashley Di Battista, Ph.D. Research Fellow Critical Care Medicine| Neurosciences & Mental Health Program The Hospital for Sick Children Toronto, ON, CanadaMedicalResearch.com Interview with: Ashley Di Battista, Ph.D. Research Fellow Critical Care Medicine| Neurosciences & Mental Health Program The Hospital for Sick Children  Toronto, ON, Canada Medical Research: What is the background for this study? What are the main findings? Dr. Di Battista: Most of what is known about adolescent quality of life (QoL) after traumatic brain injury (TBI) doesn’t come from adolescents – it comes from their parents.  This profoundly non- concordant data (known as the “Proxy Problem”) is drawn from parent reported health-related quality of life (HRQoL) questionnaires (e.g. the PedsQL ™).  Parent report can be influenced by the parents’ own distress after their child’s traumatic brain injury – which results in parents providing poorer estimates of their child’s QoL.  Lack of insight is often purported to explain this difference, in the absence of direct examination of insight, or subsequent data, to support this claim.  HRQoL has been criticized in the broader wellbeing literature as incompatible with the QoL construct– due to the absence of core features of the overall QoL model, and an inherent suggestion that a lack of overt pathology is equivalent to a good outcome. Proxy reported, HRQoL focused research has generated a polarized view of quality of life after pediatric traumatic brain injury. This misrepresentation is due in part to the way in which we acquire this data (e.g. the tools) and who we ask (e.g. parents). The current study explored the individual adolescent experience of quality of life after traumatic brain injury and whether the tools commonly used to assess quality of life after brain injury are of capturing what adolescents define as relevant to their definition of quality of life. Our findings revealed that when adolescents did endorse changes in functioning on the PedsQL, they did not consider these changes to be relevant to, or impact on, their self-described QoL. While the PedsQL™ is capable of documenting changes post-injury, it does not seem to capture domains of relevance to the adolescent idea of QoL. The ability of these adolescents to reflect on their own circumstances, engage in pre-to-post injury analysis of their functioning challenges default positioning that lack of insight is the sole determinant for differences in reports between proxies and adolescents on quality of life .
BMJ, Heart Disease, Hospital Readmissions, Yale / 06.02.2015

MedicalResearch.com Interview with: Kumar Dharmarajan MD MBA Section of Cardiovascular Medicine Yale University School of Medicine, New Haven, CT 06510 Medical Research: What is the background for this study? What are the main findings? Dr. Dharmarajan: We know that patients are at high risk for rehospitalization and death in the month after hospital discharge. Yet little is known about how these risks dynamically change over time for the full year after hospitalization. This information is needed for patients and hospitals to set realistic goals and plan for appropriate care. We found that the risk of rehospitalization and death decline slowly following hospitalization and remain elevated for many months. We also found that specific risk trajectories vary by discharge diagnosis and outcome. For example, risk remains elevated for a longer period of time following hospitalization for heart failure compared with hospitalization for acute myocardial infarction. For all 3 conditions we studied (heart failure, heart attacks, and pneumonia), risk of rehospitalization remained elevated for a longer period of time than the risk of death.
Author Interviews, CDC, OBGYNE, Occupational Health / 06.02.2015

MedicalResearch.com Interview with: Barbara Grajewski, Ph.D., M.S., Epidemiologist Elizabeth Whelan, Ph.D., Branch Chief Christina Lawson, Ph.D., Epidemiologist Division of Surveillance, Hazard Evaluations and Field Studies National Institute for Occupational Safety and Health Centers for Disease Control and Prevention Medical Research: What is the background for this study? Response: The study, published January 5 online ahead of print in the journal Epidemiology, looked at potential workplace reproductive hazards for flight attendants. While in flight, flight attendants are exposed to cosmic radiation from space and, periodically, can be exposed to radiation from solar particle events. Flight attendants can also experience circadian disruption (disruption to the body’s internal time clock) from traveling across time zones and from working during hours when they would normally be asleep. For this study, we analyzed 840 pregnancies among 673 female flight attendants and examined company records of 2 million single flights flown by these women. From these data, we estimated a marker of circadian disruption—working during normal sleeping hours—and exposure to cosmic and solar particle event radiation for each flight. This gives us a much more specific estimate of the exposures these workers face on the job every day. We also assessed the physical demands of the job, such as standing and walking for more than 8 hours a day and bending at the waist more than 25 times a day. Cosmic radiation and circadian disruption among flight attendants are linked very closely on many flights and are very difficult to look at separately when trying to understand what causes miscarriage. This is the first study that has attempted to separate these two exposures to determine which is potentially linked to miscarriage. This study is also an improvement over other studies in its assessment of cosmic radiation for each individual flight flown and from documentation of solar particle events. Earlier studies have looked at how many years a flight attendant has worked or other ways to estimate exposures that are not as specific.
Author Interviews, CDC, HIV, Race/Ethnic Diversity / 06.02.2015

MedicalResearch.com Interview with: Azfar-e-Alam Siddiqi, MD, PhD Associate Chief of Science (Acting) HIV Incidence and Case Surveillance Branch Division of HIV/AIDS Prevention National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention Centers for Disease Control and Prevention Medical Research: What is the background for this study? What are the main findings? Dr. Sidiqqi: African Americans remain the population most affected by HIV in the United States -- accounting for almost half (44 percent) of all new infections and more than a third (41 percent) of people living with HIV, despite representing just 12 percent of the U.S. population. We also know that far too many African Americans living with HIV do not get the medical care and treatment they need to stay healthy and protect themselves and others. In fact, less than half (40 percent) of African Americans living with HIV are engaged in care and only one-quarter (28 percent) have the virus under control through treatment. To better understand mortality among African Americans with HIV, our team analyzed data from the National HIV Surveillance System for 2008 through 2012. Because immune suppression caused by HIV infection can result in fatal co-illnesses, our analysis estimated deaths due to all causes, rather than limiting their analysis to deaths resulting directly from HIV infection. This method allowed us to capture the fullest picture of mortality among African Americans with HIV. According to our new analysis, from 2008-2012, the death rate per 1,000 blacks living with HIV decreased 28 percent, more than the overall decline (22 percent) observed among all persons living with HIV and more than declines observed among other races/ethnicities (13 percent for whites and 25 percent for Hispanics). Despite substantial declines in mortality, the death rate per 1,000 blacks living with HIV in 2012 was 13 percent higher than the rate for whites and 47 percent higher than the rate for Hispanics.
Author Interviews, Emergency Care, Pain Research / 06.02.2015

MedicalResearch.com Interview with: Erin R. Schlemmer, MPH Health Care Manager / Epidemiologist Department of Clinical Epidemiology & Biostatistics Blue Cross Blue Shield of Michigan MedicalResearch: What is the background for this study? Response: Low back pain (LBP) is a common reason for emergency department (ED) visits. Usually, uncomplicated acute LBP is a benign, self-limited condition that can be managed without the need for imaging studies. However, national data have shown that a substantial proportion of ED patients with LBP receive imaging studies, and that the use of advanced imaging has increased considerably for this population in recent years. A number of groups (including specialty societies, a consortium of health plan medical directors, and an expert panel of emergency medicine physicians) have offered recommendations for the appropriate use of imaging for Low back pain. Within these guidelines, there are a number of “red flag” conditions that serve as indications for Low back pain imaging, and it is generally accepted that most patients do not require imaging to inform treatment of their Low back pain unless they have one or more red flags. Our objective was to use claims data from a large commercial insurer to describe the imaging indications and imaging status of patients presenting to the ED with Low back pain, and to describe demographic and healthcare use characteristics associated with non-indicated imaging. MedicalResearch: What are the main findings? Response: We found that over half (51.9%) of all patients presenting to the ED with low back pain had no claims-based evidence of indications for imaging. Overall, 36.5% of patients received imaging, and 10.2% received advanced imaging (CT or MRI). Among patients with imaging indications, the most common indication was trauma (71.6%), followed by cancer (24.0%). Although nearly a third of non-indicated patients received imaging, this population had a lower prevalence of imaging compared to patients with imaging indications (30.1% vs. 43.5%), and were also less likely to have prior healthcare use (such as ED visits) in the past year. Among non-indicated patients who received imaging, 26.2% received advanced imaging (CT or MRI) and 4.3% had >1 type of imaging.
Alzheimer's - Dementia, Author Interviews, Exercise - Fitness / 06.02.2015

MedicalResearch.com Interview with: Paula Iso-Markku, MD, Department of Clinical Physiology and Nuclear Medicine,  HUS Medical Imaging Center,  Helsinki University Central Hospital and University of Helsinki Helsinki , Finland MedicalResearch: What is the background for this study? What are the main findings? Dr. Iso-Markku : The social, financial and humane burden of the dementia is extensive as the worldwide prevalence of dementia is estimated around 35.6 million. Finding efficient prevention strategies for dementia is crucial. Within the past decade vascular risk factors have been recognized as very potential risk factors of dementia. As physical activity is known to affect vascular risk factors, it might also be a potential preventive tool against dementia. Few comprehensive epidemiological studies on physical activity in middle age and dementia occurrence later in life have been conducted. The comprehensive Finnish Twin Study offers a unique approach to the subjects as the shared growing up environment and genes can be taken into account. The study population is extensive and a good representation of the Finnish population. In this study the association of physical activity in adulthood and dementia mortality was investigated in a 29-year follow-up. The main finding in this study was that persistent vigorous (i.e. more strenuous than walking) physical activity was significantly associated with lower dementia mortality. The results in the paired analysis, comparing twins to co-twins, were similar but remained non-significant. The analyses of the volume of physical activity were, however, controversial.
Technology / 06.02.2015

MedicalResearch.com Interview with: Gautam M. Shah Vice President of Product Management at VoceraMedicalResearch.com Interview with: Gautam M. Shah Vice President of Product Management at Vocera MedicalResearch.com Editor’s Note: Vocera announced on February 5, 2015, it will “provide a cloud-based secure text messaging solution as a benefit to all of its U.S. healthcare customers, at no additional cost, for use by any of their affiliated healthcare providers. Vocera Secure Texting will connect seamlessly with Vocera Communication Systems installed in over 800 U.S. hospitals” (Vocera press release). Mr. Shah, from Vocera, answers some questions regarding this new technology for the readers of MedicalResearch.com below. MedicalResearch: What is the background for this technology? Mr. Shah: The Vocera Secure Texting solution is a cloud-based, secure, HIPAA-compliant texting application that seamlessly integrates with the Vocera Communication System.  The solution will allow physicians to securely communicate with all members of their patient's care team, while helping hospital CIOs improve security associated with protecting personal health information (PHI). MedicalResearch: How will this texting method facilitate communication among health care providers? Mr. Shah: This solution is being offered to all of our 800+ U.S. hospital customers at no cost, and to new customers for a nominal fee. Vocera Secure Texting will connect seamlessly with our award-winning communication system to enable physicians to securely text care teams and improve care coordination, operational efficiencies, and patient experience. What’s unique about Vocera Secure Texting is that it combines the convenience physicians need with the security health systems require. Our new secure texting app will be easy to use and provide a HIPAA-compliant alternative to SMS, as well as basic communication and collaboration capabilities for physicians and care teams.
Asthma, Author Interviews, Infections / 06.02.2015

Meghan F. Davis, DVM MPH PhD Assistant Professor Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public HealthMedicalResearch.com Interview with: Meghan F. Davis, DVM MPH PhD Assistant Professor Department of Environmental Health Sciences Johns Hopkins Bloomberg School of Public Health   Medical Research: What is the background for this study? What are the main findings? Dr. Davis: Asthma rates have been on the rise, particularly in children. Interventions targeted at allergens and other environmental factors known to exacerbate asthma are only partially successful, suggesting a role for novel drivers of morbidity among existing patients with asthma. In this study, we evaluated associations between nasal colonization with the bacterium Staphylococcus aureus and symptoms related to wheeze and asthma using data from the nationally-representative NHANES database. We found that S. aureus nasal colonization was associated with asthma symptoms in children and young adults, but not in older adults.