Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, JAMA / 22.08.2018

MedicalResearch.com Interview with: Chana A. Sacks, MD, MPH Program On Regulation, Therapeutics, And Law (PORTAL) Division of Pharmacoepidemiology and Pharmacoeconomics Brigham and Women’s Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Combination pills combine multiple medications into a single dosage form. There have been case reports in recent years of high prices for certain brand-name combination drugs – even those that are made up of generic medications. Our study looks at this phenomenon in a systematic way using recently released Medicare spending data. We evaluated 29 combination drugs and found that approximately $925 million dollars could potentially have been saved in 2016 alone had generic constituents been prescribed as individual pills instead of using the combination products. For example, Medicare reported spending more than $20 per dose of the combination pill Duexis, more than 70 times the price of its two over-the-counter constituent medications, famotidine and ibuprofen. The findings in this study held true even for brand-name combination products that have generic versions of the combination pill. For example, Medicare reported spending more than $14 for each dose of brand-name Percocet for more than 4,000 patients, despite the existence of a generic combination oxycodone/acetaminophen product. (more…)
Author Interviews, Breast Cancer, Cancer Research, Chemotherapy, Radiation Therapy / 22.08.2018

MedicalResearch.com Interview with: Kathleen Horst, MD Associate Professor of Radiation Oncology (Radiation Therapy) Stanford University Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: We were interested in focusing on young women with breast cancer as this is a high-risk patient population that is not studied on its own in clinical trials. Furthermore, the available data on treating breast cancer with neoadjuvant chemotherapy (NAC) does not include detailed outcomes for women under the age of 40 years. Because most women who are diagnosed with breast cancer in this age group will have aggressive disease, most of them will be treated with NAC followed by surgery. From prospective randomized trials we know that women with breast cancer who attain a pathologic complete response (PCR) to neoadjuvant chemotherapy fare significantly better than those who do not. In addition, existing data suggest that a complete response in the lymph nodes also portends a better prognosis. This is the foundation for the currently ongoing NSABP B-51/RTOG 1304 trial, which is evaluating the role of nodal irradiation in those women who attain a pathologic complete response in the lymph nodes after NAC. We wanted to know whether differences in pathologic response in the breast versus lymph nodes led to different clinical outcomes in this patient group. We evaluated outcomes following neoadjuvant chemotherapy for breast cancer in 155 women age 40 and younger. We focused on pathologic response in the breast and lymph nodes as predictors of disease recurrence and survival. We found that any residual disease in either the breast or lymph nodes lessened the chance of cure significantly. Importantly, women who attained a complete response in the lymph nodes but continued to have residual disease in the breast fared just as poorly as those who remained lymph node positive following neoadjuvant chemotherapy.  (more…)
Aging, Author Interviews, Cannabis, Mental Health Research, Schizophrenia / 22.08.2018

MedicalResearch.com Interview with: Dr. Daniel G. Amen MD Amen Clinics, Inc., Founder Costa Mesa, CA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In the largest known brain imaging study, scientists evaluated 62,454 brain SPECT (single photon emission computed tomography) scans of more than 30,000 individuals from 9 months old to 105 years of age to investigate factors that accelerate brain aging. SPECT was used to determine aging trajectories in the brain and which common brain disorders predict abnormally accelerated aging. It examined these functional neuroimaging scans from a large multi-site psychiatric clinic from patients who had many different psychiatric disorders, including bipolar disorder, schizophrenia and attention deficit hyperactivity disorder (ADHD).  Researchers studied 128 brain regions to predict the chronological age of the patient. Older age predicted from the scan compared to the actual chronological age was interpreted as accelerated aging.  The study found that a number of brain disorders and behaviors predicted accelerated aging, especially schizophrenia, which showed an average of 4 years of premature aging, cannabis abuse (2.8 years of accelerated aging), bipolar disorder (1.6 years accelerated aging), ADHD (1.4 years accelerated aging) and alcohol abuse (0.6 years accelerated aging).  Interestingly, the researchers did not observe accelerated aging in depression and aging, which they hypothesize may be due to different types of brain patterns for these disorders. (more…)
Author Interviews, JAMA, Mental Health Research, Pediatrics / 22.08.2018

MedicalResearch.com Interview with: Dr Alexandra Rouquette MD PhD Center for Research in Epidemiology and Population... French Institute of Health and Medical Research Paris MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is a growing number of clues in the literature that suggest that the onset of adult psychopathologic disorders can be traced back to behavioral or emotional symptoms observed in childhood or adolescence. Targeting early childhood symptoms might thus be effective in preventing future mental disorders. However, these interventions are challenging to implement because we lack knowledge on which specific childhood symptoms have predictive associations with adult psychopathologic disorders. In our study, we used a novel methodologic approach, the network perspective, in which symptoms are conceptualized as distinct entities that can causally influence each other, be self-reinforcing and are thus part of causal chains which can culminate in disorders. We investigated longitudinally the network structure among a broad range of emotional and behavioral symptoms (symptoms of attention deficit, symptoms of hyperactivity, disruptive symptoms, internalizing symptoms, prosocial symptoms) collected in elementary school girls (6-10 years) included in the Quebec Longitudinal Study of Kindergarten Children. We showed that symptoms “irritable”, “blames others”, “not liked by other children”, “often cries”, and “solitary” retained a distinctive position in the network because most of the direct relationships between the disruptive and internalizing symptom clusters transited through them. These symptoms have been termed bridge symptoms in the network perspective, as they constitute pathways that can connect different disorders. We then investigated the relationships between this emotional and behavioral symptoms network in childhood and the occurrence of anxiety disorders at age 15 and 22 years. Importantly, the bridge symptoms (particularly “not liked by other children” and “irritable”) exhibited the strongest relationships with future anxiety disorders. (more…)
Author Interviews, Memory, Pediatrics, Sleep Disorders / 22.08.2018

MedicalResearch.com Interview with: Dr. Rebecca Spencer PhD Associate Professor Department of Psychological and Brain Sciences University of Massachusetts MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know that in young adults, sleep contributes to emotion processing. We wondered if naps work similarly for preschool children.  To look at this, we had children learn an emotional memory task and then either take a nap or stay awake.  We then tested their memory after that interval and again the next day. We found that when children napped, they had better memory for those items the next day than if they did not nap.  That the naps seem to support memory (even if in a delayed fashion) seems consistent with the observation of parents and preschool teachers that children are often emotionally dysregulated if they do not nap. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare, NYU, Prostate Cancer / 22.08.2018

MedicalResearch.com Interview with: Danil V. Makarov, MD, MHS Department of Urology and Department of Population Health New York University Langone School of Medicine VA New York Harbor Healthcare System, Robert F. Wagner Graduate School of Public Service Cancer Institute, New York University School of Medicine, New York MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Reducing prostate cancer staging imaging for men with low-risk disease is an important national priority to improve widespread guideline-concordant practice, as determined by the National Comprehensive Cancer Network guidelines. It appears that prostate cancer imaging rates vary by several factors, including health care setting. Within Veterans Health Administration (VHA), physicians receive no financial incentive to provide more services. Outside VHA, the fee-for-service model used in Medicare may encourage provision of more healthcare services due to direct physician reimbursement. In our study, we compared these health systems by investigating the association between prostate cancer imaging rates and a VA vs fee-for-service health care setting. We used novel methods to directly compare Veterans, Medicare Recipients, and Veterans that chose to receive care from both the VA at private facilities using Medicare insurance through the Choice Act with regard to rates of guideline-discordant imaging for prostate cancer. We found that Medicare beneficiaries were significantly more likely to receive guideline-discordant prostate cancer imaging than men treated only in VA. Moreover, we found that men with low-risk prostate cancer patients in the VA-only group had the lowest likelihood of guideline-discordant imaging, those in the VA and Medicare group had the next highest likelihood of guideline-discordant imaging (in the middle), and those in the Medicare-only group had the highest likelihood of guideline-discordant imaging.  (more…)
Author Interviews, Neurology, Social Issues / 22.08.2018

MedicalResearch.com Interview with: Prof. Carmen Sandi Director, Brain Mind Institute Laboratory of Behavioral Genetics Brain Mind Institute Ecole Polytechnique Federale de Lausanne Switzerland  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Social hierarchies are pervasive and social status has deep consequences for health, wellbeing and societal organizations. Socially dominant individuals have priority access to resources and are more likely to become leaders. Although there are drastic differences in the predisposition of individuals to attain or strive for dominance, very little is known regarding the factors that predispose individuals to attain dominance. Does dominance become visible only in social context? Here, we performed five behavioral experiments and consistently found that individuals high in dominance are faster than less dominant ones to respond in choice situations, though not less accurate, which suggests that promptness to respond may predispose individuals to become dominant. Strikingly, using high-density EEG, we find that promptness to respond in dominant individuals is reflected in a strongly amplified brain signal at approximately 240 ms post-stimulus presentation. At this latency, participants’ reaction times were negatively correlated with activity in the cingulate cortex. Our results may open a new research approach using EEG signatures as a measure for dominance, independent of social context. (more…)
Alcohol, Author Interviews, Neurology / 22.08.2018

MedicalResearch.com Interview with: Erica Grodin, Ph.D. Postdoctoral Fellow Dept. of Psychology and Psychiatry University of California  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The hallmark of addictive disorders, including alcohol use disorder, is drug use that continues despite negative consequences. This pattern of use is referred to as “compulsive” and is one of the major barriers to treating addiction. We don’t yet fully understand what brain regions are responsible for compulsive alcohol use. Our study used a neuroimaging method called functional magnetic resonance imaging which allows us to see which areas of the brain are more active when an individual is performing a task. To investigate what brain regions are involved in compulsive alcohol seeking, we designed a task during which study participants could try to earn alcohol and food points at the risk of receiving a negative consequence, an electric shock. Study participants were light drinkers (men who drank <15 drinks/week and women who drank <10 drinks/week) and heavy drinkers (men who drank ≥20 drinks/week and women who drank ≥15 drinks/week). We found that heavy drinking individuals were more likely to try to earn alcohol points that were paired with a potential negative consequence than light drinkers were. This behavior of compulsive alcohol seeking was associated with increased brain activation in the medial prefrontal cortex, anterior insula, and ventral and dorsal striatum.  (more…)
Addiction, Author Interviews, Opiods / 21.08.2018

MedicalResearch.com Interview with: Bikram Subedi, PhD Assistant Professor of Analytical Chemistry Murray State University, Murray KYBikram Subedi, PhD Assistant Professor of Analytical Chemistry Murray State University, Murray KY MedicalResearch.com: What is the background for this study? What are the main findings? Response: The USA is one of the major consumers of diverse neuropsychiatric and illegal drugs, and recently declared a national public health emergency on opioid abuse. Law enforcement typically utilized conventional methods of determining drug consumption rate which are based on survey questionnaire, hospital admissions, drug-related crime statistics, and self-reported information. Conventional methods typically underestimate the actual consumption rate of drugs. Our new approach of determining consumption rates of drugs in community is time and cost effecting and comprehensive. Based on levels of drugs quantified from raw sewage, the per capita consumption rates of several illicit drugs including methamphetamine, amphetamine, cocaine, and THC in two communities of Western Kentucky (similar population and only ~50 miles apart) were significantly different. During special events such as July 4th and 2017 solar eclipse, the consumption rates were found even higher. The consumption rate of methamphetamine was among one of the highest ever reported in the country.  (more…)
Author Interviews, Breast Cancer, Cancer Research, Genetic Research, JAMA, Ovarian Cancer / 21.08.2018

MedicalResearch.com Interview with: Ambry GeneticsShuwei Li, PhD Principal Statistical Geneticist Ambry Genetics MedicalResearch.com: What is the background for this study? What are the main findings? Response: Breast cancer is the most commonly diagnosed cancer, while ovarian cancer is the fifth leading cause of death due to cancer, in US women. Since the discovery of BRCA1 and BRCA2, multiple genes have been reported as risk factors; however, it is still unclear whether the known findings represent the complete genetic landscape of breast and ovarian cancers. Our team performed exome sequencing on more than 10,000 breast and/or ovarian cancer patients and nearly 4,000 controls. We observed increased risk of breast cancer associated with PALB2, ATM, CHEK2 and MSH6 genes, and increased risk of ovarian cancer associated with MSH6, RAD51C, TP53 and ATM genes.   (more…)
ALS, Author Interviews, Neurology / 21.08.2018

MedicalResearch.com Interview with: Pier Lorenzo Puri, M.D PhD Professor in the Development, Aging and Regeneration Program Sanford Burnham Prebys Medical Discovery Institute  MedicalResearch.com: What is the background for this study? What are the main findings? Response: My lab has been studying special repair cells called fibro-adipogenic progenitors (FAPs) and how these cells change in models of motor neuron diseases. These cells usually repair muscles after acute injury. But we are finding the FAPs change dramatically in disease settings. In this study we looked at these cells in models of spinal cord injury, ALS and spinal muscular atrophy, including muscle tissue from ALS patients. We found that FAPs change radically in several ways. Most importantly, the cells used a different signaling pathway, IL-6-STAT3, and when we blocked this signaling muscle atrophy and fibrosis halted. While further studies in humans are needed, this is a promising finding as FDA-approved medicines that block IL-6 and STAT3 are available.  (more…)
Author Interviews, JAMA / 21.08.2018

MedicalResearch.com Interview with: Mehraneh Dorna Jafari, MD Assistant Professor Associate Program Director Colon and Rectal Surgery UC Irvine Health MedicalResearch.com: What is the background for this study? What are the main findings? Response: Financial ties between medical and surgical device companies and clinicians are very common. It has been shown that up to 94% of physicians in the United States receive a form of benefit from an external company. When we evaluate published works, it is important to assess the integrity and academic credentials of the authors. In 2013, the Centers for Medicare and Medicaid Services established the Open Payments Database to house industrial payments’ information and increase transparency into the reporting of payments. In our study, we found that in only 37% of their relevant 2016 publications were the Conflict of Interests declared by the authors. (more…)
Accidents & Violence, Author Interviews, Pediatrics / 21.08.2018

MedicalResearch.com Interview with:, Motao Zhu, MD, MS, PhD Principal Investigator Center for Injury Research and Policy The Research Institute at Nationwide Children’s Hospital? Columbus, OHMotao Zhu, MD, MS, PhD Principal Investigator Center for Injury Research and Policy The Research Institute at Nationwide Children’s Hospital? Columbus, OH MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know that texting while driving occurs frequently among teen drivers. This study looks at the differences of texting while driving among teens between states. Motor vehicle crashes continue to be the leading cause of death among teenagers in the United States. In 2016, over 2,000 teens in the US aged 14-18 years died in motor vehicle crashes and nearly 260,000 were seriously injured in traffic-related incidents. Even though there are cheap car insurance brokers available, teen motor vehicle crashes are preventable, and proven strategies can improve the safety of young drivers on the road. Among distracted driving, texting while driving may be especially risky because it involves at least three types of driver distraction: visual, physical, and cognitive. Texting while driving is banned for all drivers in 47 states and the District of Columbia, yet this study shows it still occurs regularly among teen drivers. Overall (nationally), about 40% of high school student drivers text while driving at least once/month. The rate varies among states. The lowest is 26% (Maryland) and highest is 64% (South Dakota). Texting while driving among high school student drivers is highest in Montana, Wyoming, North Dakota, South Dakota, and Nebraska. These results were not surprising. There are state level factors to explain them. The top 5 highest texting while driving among high school student drivers (Montana, Wyoming, North Dakota, South Dakota, and Nebraska) are rural states with a high percent of high school student drivers and students can get their learners permit by age 15. (more…)
Alcohol, Author Interviews, Mental Health Research / 21.08.2018

MedicalResearch.com Interview with: “Energy drink” by joelklal is licensed under CC BY 2.0Barbara D. Fontana Laboratory of Experimental Neuropsychobiology, Department of Biochemistry and Molecular Biology Natural and Exact Sciences Center Graduate Program in Biological Sciences Toxicological Biochemistry, Federal University of Santa Maria, Santa Maria, Brazil  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Our research group has been working with taurine and alcohol association for a long time. The background for this study is around increased consumption of molecules present in energy drinks frequently used as mixers for alcoholic beverages. Taurine is one of the most abundant molecules found in energetic drinks and has a neuromodulatory role in brain. In this context, we explore the effects of taurine associated to alcohol. Thus, as result we observed that this association exacerbate risky choices and reduces social cohesion in zebrafish, having a negative impact in social and fear-related behavior. (more…)
Annals Internal Medicine, Author Interviews, Neurology, Opiods / 21.08.2018

MedicalResearch.com Interview with: Tara Gomes, MHSc Li Ka Shing Knowledge Institute, St Michael’s Hospital, The Institute for Clinical Evaluative Sciences Leslie Dan Faculty of Pharmacy Department of Health Policy, Management, and Evaluation University of Toronto, Toronto, Ontario, Canada  MedicalResearch.com: What is the background for this study? Response: Pregabalin is a medication increasingly being prescribed to manage pain, however there is emerging evidence that this drug may increase one's risk of opioid overdose when prescribed with opioids. (more…)
Author Interviews, Technology / 21.08.2018

MedicalResearch.com Interview with:| Dr. Wendy L. Frankel, MD. Kurtz Chair and Distinguished Professor and Dr. Anil Parwani, MD, PhD, MBA, Associate Professor Wexner Medical Center The Ohio State University MedicalResearch.com: What is the background for this work? How does digital pathology differ from traditional H/E specimens?  Is there is different processing method?  Difference in prep time or costs? Response: Traditional pathology involves patient tissue coming to the lab and being processed. The end result is a glass slide with a stained tissue that pathologists use under a microscope. The process in digital pathology is the same, up until the point right after when the glass slide is made. In digital pathology, we put the glass slide under a scanner instead of under a microscope. The scanner creates a large file image that can be reviewed remotely by pathologists around the world. The advantage of digital pathology, and the reason we are doing this at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC - James), is because when the slide is digitized, the image can be rapidly shared with an expert for review, or another institute that the patient may be going to. In addition, I can look at the image and ask the computer to quantitate different types of features that are present in the sample. While this has historically been done manually with a microscope, it’s been a more subjective process that is open to human error. On top of that, we now have computer programs that allow us to ask very specific questions about the sample. For example, we can ask how many nuclei are in the field, how many of the nuclei show signs of cancer, and the size and color of the nucleus. These programs make the whole diagnostic process more objective and standardized. This is something we just can’t do by looking at a glass slide under a microscope. Finally, you can also use these images for presentations at clinical conferences or for teaching residents, fellows or other pathologists. You now have the means to create an archive of patient slides and have it instantaneously available. (more…)
Author Interviews, Cancer Research, JAMA, Pediatrics / 20.08.2018

MedicalResearch.com Interview with: Rebecca D. Kehm, PhD Division of Epidemiology and Community Health University of Minnesota School of Public Health Minneapolis, MN   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Racial and ethnic differences in childhood cancer survival have long been known, and there has been some research indicating that SES could explain disparities. However, our study is the first to use statistical methods that put numbers to the relative contribution of SES to survival disparities for different types of childhood cancer. We set out to investigate whether racial and ethnic disparities in childhood cancer survival are attributed to underlying differences in socioeconomic status, defined as one’s social and economic position in relation to others based on income, education, and occupation, which scientists abbreviate as SES. Our findings provide evidence that SES does in fact contribute to racial and ethnic disparities in survival for some types of childhood cancer. Specifically, we found that SES accounted for 28-73% of the racial and ethnic survival disparity for acute lymphoblastic leukemia, acute myeloid leukemia, neuroblastoma, and non-Hodgkin lymphoma. However, SES did not significantly contribute to racial and ethnic disparities in survival for other types of childhood cancer including central nervous system tumors, soft tissue sarcomas, Hodgkin lymphoma, Wilms tumor, and germ cell tumors. These tumor-specific results help inform where to place resources to best reduce racial and ethnic survival disparities for each of the major types of childhood cancer. (more…)
Author Interviews, Biomarkers, CMAJ, Heart Disease / 20.08.2018

MedicalResearch.com Interview with: Peter Kavsak, PhD, FCACB, FAACC, FCCS Professor, Pathology and Molecular Medicine McMaster University  MedicalResearch.com: What is the background for this study? Response: For patients who present to the hospital with symptoms suggestive of acute coronary syndrome (ACS) the preferred blood test to help physicians in making a diagnosis is cardiac troponin. Recent studies have demonstrated that a very low or undetectable cardiac troponin level when measured with the newest generation of blood tests (i.e., the high-sensitivity cardiac troponin tests) in this population may rule-out myocardial infarction (MI or a heart attack) on the initial blood sample collected in the emergency department, thus enabling a faster decision and foregoing the need for subsequent serial measurements of cardiac troponin over several hours as recommended by the guidelines. The problem with this approach, however, is that using high-sensitivity cardiac troponin alone to do this has not reliably been demonstrated to achieve a sensitivity >99% for detecting MI, which is the estimate that most physicians in this setting consider as safe for discharge. Our study goal was to compare the diagnostic performance of a simple laboratory algorithm using common blood tests (i.e., a clinical chemistry score (CCS) consisting of glucose, estimated glomerular filtration rate (eGFR), and either high-sensitivity cardiac troponin I or T) to high-sensitivity cardiac troponin alone for predicting MI or death within the first month following the initial blood work. (more…)
Author Interviews, Cancer Research, Pharmaceutical Companies / 20.08.2018

MedicalResearch.com Interview with: Jeffrey S. Humphrey, MD President of Kyowa Kirin Pharmaceutical Development, Inc MedicalResearch.com: What is the background for this announcement? Would you briefly explain what is meant by Mycosis Fungoides and Sézary Syndrome? Response: Kyowya Kirin has received FDA approval for Poteligeo (mogamulizumab), based on findings from the MAVORIC trial. Mogamulizumab is a humanized immunoglobulin G1 (IgG1) monoclonal antibody (mAb) that targets CC chemokine receptor 4 (CCR4), for the treatment of the most common subtypes of cutaneous T-cell lymphoma (CTCL), mycosis fungoides (MF) and Sézary syndrome (SS). MF and SS may have a profound and severe impact on quality of life, including a patient’s functional, emotional and social well-being, as symptoms may include a scaly red rash or light or dark patches in areas of the body that are not usually exposed to the sun; thin, reddened, eczema-like rash; thickened scaly, red skin (or plaques) or psoriasis-like rash; more advanced disease can include tumors (with significant thickness) on the skin, which may develop ulcers and become infected. Because CTCL manifests in skin lesions, it is often mistaken for other skin conditions (early stage MF and SS can be diagnosed as other skin conditions), which can delay conclusive diagnosis and treatment options. MF is the most common subtype of CTCL, affecting 50-70% of individuals. In most patients diagnosed with early stage MF, the skin involvement does not progress, but in some patients, it will slowly progress. SS accounts for approximately 3% of CTCL cases and is a more aggressive, leukemic form of CTCL, affecting the blood, skin, lymph nodes and visceral organs (more…)
AACR, Author Interviews, Cancer Research, Imperial College, Kidney Disease / 20.08.2018

MedicalResearch.com Interview with: Dr. David C. Muller PhD Faculty of Medicine, School of Public Health Research Fellow in Epidemiology and Biostatistics Imperial College, London MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our colleagues in the U.S. have been working on KIM-1 for years, particularly in the context of chronic kidney disease. Recently they found that KIM-1 is also elevated at the time of diagnosis of kidney cancer. We wanted to see if KIM-1 concentrations could predict the chances of a future diagnosis of kidney cancer. We found that KIM-1 was a strong predictor of being diagnosis with kidney cancer in the next 5 years. We also found that higher pre-diagnostic KIM-1 was associated with worse survival after diagnosis.  (more…)
Author Interviews, Medicare, Race/Ethnic Diversity / 20.08.2018

MedicalResearch.com Interview with: Kim Lind, PhD, MPH Research Fellow Centre for Health Systems and Safety Research Australian Institute of Health Innovation Macquarie University, NSW MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Medicare Annual Wellness Visit (AWV) is a preventive care visit that was introduced in 2011 as part of the Patient Protection and Affordable Care Act. Prior to this, the only preventive care exam covered by Medicare was the Welcome to Medicare Visit, which is only available for people in their first year of Medicare enrolment. The AWV is available each year to beneficiaries without co-payment to people who are past their first year of Medicare enrolment. The AWV focuses on prevention and early detection of disease. Racial disparities in healthcare utilization and health outcomes have been well documented in the US. Prior expansions of Medicare coverage have had varied effects on reducing disparities. For example, in 2001 Medicare began to cover colorectal cancer screening which reduced racial disparities for some minority groups with respect to screening rates and improved early detection. Expanding coverage of preventive care for people on Medicare may help reduce disparities in health outcomes, but we first needed to know if people were using the Medicare Annual Wellness Visit. Our goal was to assess AWV utilization rates and determine if utilization differed by race or ethnicity. We analyzed a nationally representative database of Medicare beneficiaries (the Medicare Current Beneficiary Survey) that included self-reported race, ethnicity, income and education, linked to Medicare claims. We found that Medicare Annual Wellness Visit use was low but increased from 2011 to 2013. We also found that people on Medicare who self-identified as belonging to a racial or ethnic minority group had lower AWV utilization rates than non-Hispanic white people. People with lower income or education, and people living in rural areas had lower Medicare Annual Wellness Visit utilization.  (more…)
Author Interviews, Social Issues / 19.08.2018

MedicalResearch.com Interview with: “3-men-laughing” by desthal is licensed under CC BY-NC-ND 3.0Menelaos Apostolou  PhD University of Nicosia Cyprus MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In this study I analyzed 6794 responses from a recent Reddit thread on why men were single, and I classified them in 43 reason categories. Among the most frequent reasons that men indicated for being single included poor flirting skills, low self-confidence, poor looks, shyness, low effort, and bad experience from previous relationships. (more…)
Annals Internal Medicine, Author Interviews, Diabetes, Kaiser Permanente, Surgical Research, Weight Research / 18.08.2018

MedicalResearch.com Interview with: David Arterburn, MD, MPH Kaiser Permanente Washington Health Research Institute Seattle, WA MedicalResearch.com: What is the background for this study? What are the main findings? Response: More than 9 percent of adult Americans—about 30 million people—are estimated to have type 2 diabetes, according to the American Diabetes Association. The disease tends to worsen over time, with blood sugar levels rising along with the risks of developing large blood vessel (macrovascular) complications like heart attack and stroke, as well as small blood vessel (microvascular) complications affecting the nerves of the feet and hands (neuropathy), kidneys (nephropathy), and eyes (retinopathy). Among more than 4000 patients who underwent bariatric surgery, the 5-year incidence of microvascular disease — including neuropathy, nephropathy, and retinopathy — was nearly 60% lower than that of 11,000 matched nonsurgical control patients receiving usual diabetes care.  (more…)
Author Interviews, Cannabis, Cognitive Issues, Memory / 18.08.2018

MedicalResearch.com Interview with: Dr. Italia V. Rolle, PhD and Dr. Tim McAfee, MD Office on Smoking and Health National Center for Chronic Disease Prevention and Health Promotion CDC Ana Maria Sebastião, PhD Professor of Pharmacology and Neurosciences Director Institute of Pharmacology and Neurosciences, Faculty of Medicine and Francisco Mouro, PhD Unit of Neurosciences, Institute of Molecular Medicine University of Lisbon, Portugal MedicalResearch.com: What is the background for this study? What are the main findings?  Response: There is pressing need to comprehend how cannabinoid exposure impacts brain functioning. While cannabinoid-related research has increased exponentially in the last decade, the mechanisms through which cannabinoids affect brain functioning are still elusive. Specifically, we need to know how prolonged cannabinoid exposure affects important cognitive processes, such as memory, and also find the roots of those effects. This is particularly relevant considering that several countries have already approved cannabis-based medicines. In this sense, our work sheds new light into the mechanisms underlaying the memory-deficits provoked by a continuous exposure to a cannabinoid drug. More precisely, using brain imaging techniques, we found that long-term exposure to a synthetic cannabinoid drug impairs the ability of key brain regions involved in learning and memory to communicate with each other. Our data points to the necessity of considering cannabinoid actions in a broader perspective, including brain circuitry and communication.  (more…)
Author Interviews, Pediatrics, Pulmonary Disease, Tobacco Research / 18.08.2018

MedicalResearch.com Interview with: “#smoke” by Seniju is licensed under CC BY 2.0Ryan Diver MSPH Director, Data Analysis American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Secondhand smoke is known to have adverse effects on the lung and vascular systems in both children and adults. But it is unknown whether childhood exposure to secondhand smoke is associated with mortality in adulthood. To explore the issue, we examined associations of childhood and adult secondhand smoke exposure with death from all causes, ischemic heart disease, stroke, and chronic obstructive pulmonary disease among 70,900 never-smoking men and women from the Cancer Prevention Study II Nutrition Cohort. Study participants, primarily ages 50 to 74 at the beginning of the study, answered questions about their secondhand smoke exposure during childhood and as adults and were followed for 22 years. Those who reported having lived with a daily smoker throughout their childhood had 31% higher mortality from chronic obstructive pulmonary disease compared to those who did not live with a smoker. Although the study counted only deaths, the increase in fatal COPD implies that living with a smoker during childhood could also increase risk of non-fatal COPD. In addition, secondhand smoke exposure (10 or more hours/week) as an adult was associated with a 9% higher risk of all-cause mortality, a 27% higher risk of death from ischemic heart disease, a 23% higher risk of death from stroke, and a 42% higher risk of death from COPD. (more…)
Author Interviews, Clots - Coagulation, Emergency Care, Pulmonary Disease, Stanford / 18.08.2018

MedicalResearch.com Interview with: Joseph Bledsoe MD, FACEP Clinical Assistant Professor of Emergency Medicine Stanford Medicine Director of Research Department of Emergency Medicine Intermountain Medical Center Murray, UT 84157 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Patients with blood clots in the lungs (pulmonary embolism) (PE) are routinely admitted to the hospital for blood thinning medications in the United States. However, evidence from other countries has shown that with appropriate risk stratification patients may be safe for outpatient treatment for their PE. Our study is the largest prospective management study in the US to evaluate home treatment of patients with acute pulmonary embolism. We enrolled 200 patients and after risk stratification with the PE severity index score, leg ultrasounds and echocardiograms performed in the emergency department, patients were treated with blood thinning medications at home with routine outpatient follow up. During the 90 day follow up period we found only one patient suffered a bleeding event after a traumatic injury, without any cases of recurrent symptomatic blood clots or death.  (more…)
Author Interviews, HIV, NEJM, Yale / 17.08.2018

MedicalResearch.com Interview with: Brinda Emu, MD Assistant Professor of Medicine (Infectious Diseases) Yale School of Medicine MedicalResearch.com: What is the background for this study? Response: This was a Phase 3 study of a new antiretroviral agent, ibalizumab, for the treatment of HIV-1 infection.  Ibalizumab is a monoclonal antibody that targets the CD4 receptor on host cells.  CD4 is the receptor that HIV uses to infect CD4+ T cells.  By binding to the CD4 receptor, ibalizumab prevents viral entry.  This study recruited patients that harbor multi-drug resistant HIV and were failing their current regimen of antiretroviral agents, and thus had limited options for treatment of their HIV-1 infection using approved medications. (more…)
Author Interviews, JAMA, Surgical Research / 17.08.2018

MedicalResearch.com Interview with: Murad Alam, MD Vice-Chair and Professor of Dermatology Chief of Cutaneous and Aesthetic Surgery Northwestern University Feinberg School of MedicineMurad Alam, MD Vice-Chair and Professor of Dermatology Chief of Cutaneous and Aesthetic Surgery Northwestern University Feinberg School of Medicine MedicalResearch.com: What is the background for this study? Response: For the purposes of our study, non-invasive procedures included laser and light treatments (for brown spots, blood vessels, wrinkle reduction, scar treatment, hair removal ie laser hair removal or Hair Removal Service - sponsored), chemical peels, and non-surgical skin tightening and fat reduction (with radiofrequency energy, cold treatment, or ultrasound). These noninvasive treatments do not even break the skin, and are applied on top of the skin Then we have minimally invasive procedures, which include those that just barely break the skin, but are like getting a shot, and don’t require cutting and sewing the skin as in traditional surgery. These minimally invasive procedures include filler and neuromodulator injections to fill out the sagging aging face while reducing lines and wrinkles, as well as liposuction through tiny openings to suck out excess fat. All of these procedures and many more are available but if you do want to have a cosmetic procedure then make sure you seek out a reputable cosmetic surgeon such as Lisa Rush. In the old days, cosmetic treatments meant getting traditional plastic surgery, like a face lift or tummy tuck. These required general anesthesia, cutting and sewing the skin, significant risk of scarring, and days to weeks of recovery time. More recently, dermatologists have pioneered noninvasive and minimally invasive procedures, such as those I just described, which provide many of the same benefits as traditional plastic surgery without the risk, scars, and downtime, for example, somewhere like Rhinoplasty NYC talk about Rhinoplasties with noninvasive methods. Now these minimally invasive and noninvasive treatments have become more popular than traditional cosmetic surgery. (more…)