Author Interviews, End of Life Care, Transplantation / 09.01.2017

MedicalResearch.com Interview with: Beatriz Domínguez-Gil, MD, PhD Organización Nacional de Trasplantes Madrid Spain  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Organ shortage remains the most important barrier to the development of transplantation therapies. It leads to deaths on the waiting list, poor quality of life, increased costs to healthcare systems and emerging unethical practices as organ trafficking, mostly in the form of transplant tourism. Shortage of organs to meet the transplantation needs is a universal problem – also in Spain. The potential of donation from the deceased is decreasing or expected to decrease in most developed countries, which makes it imperative to conceive new ways of increasing organ availibility. In 2008, ONT conceived the 40 donors pmp plan, which includes the three strategies that are described in the paper: -          The identification of possible donors outside of the ICU to pose the option of intensive care to facilitate organ donation. -          The promotion of the expanded and non-standard risk donor. -          The development of donation after circulatory death The three strategies have made the country not only reach, but even surpass the objective of 40 donors pmp (43,4 in 2016). (more…)
Author Interviews, Baylor College of Medicine Houston, Genetic Research, NEJM / 09.01.2017

MedicalResearch.com Interview with: Jennifer E Posey MD, PhD Assistant Professor Department of Molecular and Human Genetics Baylor College of Medicine Tamar Harel MD, PhD Clinical Genetics Academic Research Fellow Department of Molecular and Human Genetics Baylor College of Medicine Current affiliation: Department of Genetic and Metabolic Diseases Hadassah-Hebrew University Medical Center Jerusalem, Israel MedicalResearch.com: What is the background for this study? What are the main findings? Response: As physician scientists and geneticists, our goal is to understand how genetic variation in each of us can impact health and disease. Physicians are often taught that the simplest explanation for a medical condition is the most correct explanation, and have historically searched for a single unifying diagnosis. However, in our own practice, we have met – and learned from – individuals who have more than one genetic condition affecting their health. In the past, it was difficult for physicians to diagnose such individuals. Genetic testing required a physician to recognize the potential for more than one genetic diagnosis in an individual. Single-gene and gene panel testing provided an additional barrier to accurate diagnoses, as they are more narrow in scope, and more than one molecular test was often needed to identify all conditions. Targeted testing also required a physician to accurately pre-suppose which combination of genetic conditions was most likely, and choose the correct targeted tests. The clinical availability of whole exome sequencing (WES) has removed these barriers: WES is a broad-based, unbiased analysis of an individual’s genetic variation that does not pre-suppose a specific genetic cause. If analysis is pursued systematically, WES can identify more than one genetic diagnosis in an individual, even when not suspected. In our study, we have been able to assess the frequency with which individuals can have more than one genetic diagnosis, and have begun to understand how genetic variation at more than one place in the genome can affect how a condition may present. We found that among 7,374 individuals referred for WES, 2,076 (28%) had a molecular diagnosis. Of these 2,076, 5% had two, three, or four molecular diagnoses. In our analyses of the clinical features that may be observed in an individual with two genetic conditions, we found that pairs of diagnoses with overlapping clinical features may be incompletely diagnosed as having one or the other condition, and pairs of diagnoses with very distinct clinical features may be erroneously diagnosed in the clinic as having an entirely new condition. (more…)
Author Interviews, Breast Cancer, Cancer Research, Colon Cancer, Cost of Health Care, Mammograms, Medical Imaging, Race/Ethnic Diversity, Radiology / 09.01.2017

MedicalResearch.com Interview with: Dr. Gregory Cooper, MD Program Director, Gastroenterology UH Cleveland Medical Center Co-Program Leader for Cancer Prevention and Control, UH Cleveland Medical Center Professor, Medicine, CWRU School of Medicine Co-Program Leader for Cancer Prevention and Control UH Seidman Cancer Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Affordable Care Act, among other features, removed out of pocket expenses for approved preventive services, and this may have served as a barrier to cancer screening in socioeconomically disadvantaged individuals. If so, then the gap in screening between socioeconomic groups should narrow following the ACA. The main findings of the study were that although in the pre-ACA era, there were disparities in screening, they narrowed only for mammography and not colonoscopy. (more…)
Author Interviews, Nature, Pain Research, Vitamin D / 09.01.2017

MedicalResearch.com Interview with: MedicalResearch.com: What is the background for this study? What are the main findings? Response: Formation of vitamin D in the skin with UVB light from the sun is a main source of vitamin D during summer months, but in the winter months the UVB light is too weak for vitamin D production. Headache prevalence has been suggested to be related to increasing latitude (less UVB light throughout the year) and possibly to be less prevalent during summer (more UVB light), which suggests a possible role for vitamin D exposure. Some previous small studies have suggested that low serum vitamin D levels might be associated with more frequent headache or migraine. Our study included 2601 men from the Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) from eastern Finland, aged 42-60 years in 1984-1989, which makes it one of the largest studies so far regarding vitamin D and headache. In our study chronic headache (occurring weakly or daily) was reported by 250 men, and men reporting chronic headache had lower serum vitamin D levels than others. When we divided the study population into four groups based on their serum vitamin D levels, the group with the lowest levels had over a twofold risk of chronic headache in comparison to the group with the highest levels. Chronic headache was also more frequently reported by men who were examined outside the summer months of June through September. (more…)
Aging, Author Interviews, Biomarkers / 09.01.2017

MedicalResearch.com Interview with: Paola Sebastiani PhD Department of Biostatistics Boston University School of Public Health Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Human life expectancy has increased steadily in the last century and has led to a growth of the elderly population and a need for prevention strategies and interventions that promote healthy aging. A challenge in assessing the effect of such interventions is ‘what to measure’ because people can age very differently from one another. Our study used 19 blood biomarkers that include for example cholesterol level and hemoglobin A1C to discover 26 biological signatures of aging in approximately 4,700 participants of the Long Life Family Study. These signatures are essentially patterns of values of the 19 biomarkers and we showed that one of these signatures is associated with better physical and cognitive functions, and reduced risk for disease and mortality compared to the most common signature in the study. Additional signatures predict varying risk for diabetes, cardiovascular and other aging-related diseases. We replicated these results in an independent data set. The associations of these biomarker signatures with physical and cognitive functions, and risk for morbidity and mortality support the conclusion that they capture different form of biological aging. (more…)
Author Interviews, Infections, Nature, Technology / 08.01.2017

MedicalResearch.com Interview with: Hyo-Jick Choi, PhD Assistant Professor, Department of Chemical and Materials Engineering University of Alberta Edmonton, AB, Canada T6G 1H9 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Respiratory diseases such as influenza transmitted either through breathing aerosols exhaled/coughed out by an infected person or through direct contact. Despite controversy over its efficacy, surgical mask has been widely used by general public during the past respiratory disease outbreaks because of low cost, easy wearability, and widespread use in normal day-to-day situation. Critical issue is that virus captured on the filter of the mask still maintains infectivity for long time, raising concerns of secondary infections and transmissions. This led us to develop a strain-nonspecific and reusable airborne virus deactivation system based on salt recrystallization principle. Salt recrystallization is hypothesized to cause deactivation of viruses transmitted through aerosols via two successive processes: 1) salt on filter fiber dissolves upon exposure to the pathogenic aerosols and 2) salt crystallizes as aerosols evaporate. To demonstrate the concept, we coated the fiber of the surgical mask filter with sodium chloride (NaCl) salt crystal and tested its performance using three different types of influenza viruses. Salt-treated filter provided higher filtration efficiency compared to non-treated regular filter and successfully destroyed multiple subtypes of influenza viruses trapped on the filter within few minutes, leading to significant infectivity loss. (more…)
Author Interviews, Cost of Health Care, NEJM / 08.01.2017

MedicalResearch.com Interview with: John Z. Ayanian, MD, MPP Director of the Institute for Healthcare Policy and Innovation and Alice Hamilton Professor of Medicine University of Michigan MedicalResearch.com: What is the background for this study? What are the main findings? Response: Our study assessed the broad economic impact of Medicaid expansion in Michigan – one of several Republican-led states that have chosen to expand Medicaid under the Affordable Care Act. About 600,000 low-income adults in Michigan are covered through the program, known as the Healthy Michigan Plan, which began in April 2014. Using an economic modeling tool that is also used to advise the state government for fiscal planning, we found that federal funding for the Healthy Michigan Plan is associated with over 30,000 additional jobs, about $2.3 billion in increased personal income in Michigan, and about $150 million in additional state tax revenue annually. One third of the new jobs are in health care, and 85 percent are in the private sector. The state is also saving $235 million annually that it would have spent on other safety net programs if Medicaid had not been expanded. Thus, the total economic impact of the Healthy Michigan Plan is generating more than enough funds for the state budget to cover the state’s cost of the program from 2017 through 2021. Beginning in 2017, states are required to cover 5 percent of the costs of care for Medicaid expansion enrollees, and the state share of these costs will rise to 10 percent in 2020. The remaining costs are covered by federal funding. (more…)
Author Interviews, Methamphetamine / 07.01.2017

MedicalResearch.com Interview with: Zoe M. Weinstein MD Assistant Professor of Medicine, Boston University Director, Addiction Consult Service Boston Medical Center Boston MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Like other chronic, life-long medical conditions such as hypertension or diabetes, opioid use disorder (OUD) requires long-term engagement in therapy; however many individuals who participate in Office Based Addiction Treatment are not able to be retained in care long-term. This observational study followed more than 1,200 patients over 12 years with the goal of identifying patient-specific factors associated with retention in the treatment program for longer than one year. While the study found that older age, female, and co-morbid psychiatric diagnosis were associated with greater odds of treatment retention beyond one year, patients who were black or Hispanic, unemployed, and had evidence of hepatitis C viral infection were associated with decreased odds of treatment retention beyond one year. (more…)
Author Interviews, Lancet, Pediatrics, Surgical Research, Weight Research / 07.01.2017

MedicalResearch.com Interview with: Dr Torsten Olbers PhD Department of Gastrosurgical Research Institute of Clinical Sciences University of Gothenburg, Sahlgrenska University Hospital Gothenburg Sweden  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The background to study was the lack of effective treatments for adolescents with severe obesity and the observation that many adults undergoing gastric bypass regret that they didn't´t do it earlier. The medical indication is to hopefully prevent development of diseases and organ damage due to cardiovascular risk factors and to enable them to have normalised psychosocial development (education, relation etc). In fact most of the adolescents undergoing surgery had parents having undergone surgery. (more…)
Author Interviews, Biomarkers, JAMA, Multiple Sclerosis / 07.01.2017

MedicalResearch.com Interview with: Prof Rogier Q Hintzen Neurologist/immunologist Head MS Centre ErasMS Dept of Neurology Erasmus MC, Rotterdam MedicalResearch.com: What is the background for this study? What are the main findings? Response: Years ago, we identified soluble (s) CD27 as a biomarker for T cell activation in body fluids, as part of my PhD study. (J Immunol. 1991 Jul 1;147(1):29-35.) As we presume the neuropathology seen in MS is guided by T cells we were interested to be able to quantify the activity of such cells in a given patient. Cerebrospinal fluid (CSF) is as close as we can get to the site of the disease process in MS, therefore we focus on biomarkers in this compartment. We found clearly elevated levels of sCD27 in CSF of Multiple Sclerosis patients versus non-inflammatory controls. In this study we investigated whether at the moment of first attack of suspected Multiple Sclerosis, quantification of CSF sCD27 can predict further progression in to a diagnosis of MS and whether sCD27 levels are correlated with later attack frequency. Indeed, we found that high sCD27 measured at this early stage predicts a more rapid diagnosis of Multiple Sclerosis and a more aggressive disease course. (more…)
Author Interviews, Environmental Risks, OBGYNE, Pediatrics / 06.01.2017

MedicalResearch.com Interview with: Nathalie Auger MD MSc FRCPC Montréal, Québec MedicalResearch.com: What is the background for this study? What are the main findings? Response: We carried out this study because congenital heart defects take a large share of birth defects, but not much is known on its risk factors. In previous research, we found that very high temperatures in the summer were associated with a greater risk of stillbirth. We sought to determine whether elevated outdoor heat could also be linked with congenital heart defects in a sample of about 700,000 pregnancies. (more…)
Author Interviews, Cancer Research / 06.01.2017

MedicalResearch.com Interview with: Rebecca Siegel, MPH Strategic Director, Surveillance Information Services American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303 MedicalResearch.com: What is the bottom line for incidence and mortality trends? Response: The bottom line for cancer mortality is that in contrast to many other major causes of death, cancer death rates continue to decline, dropping by 25% from 1991 to 2014. This translates to about 2 million fewer cancer deaths over this time period than would be expected if cancer death rates had remained at their peak. Death rates are the best measure of progress against disease. Cancer incidence rates also dropped in men over the past decade of data, whereas in women they are flat. The drop in men is because of large declines for the top 3 cancers (prostate, lung, and colorectum), which account for more than 40% of cancers diagnosed in men. The stable trend in women is largely because declines in lung and colorectal cancers are offset by a flat trend for both breast and uterine corpus (i.e., endometrial) cancers, which combined account for almost 40% of cases in women, as well as rapid increases for thyroid cancer over the past decade -- increasing by almost 5% annually. Importantly, thyroid incidence rates have stabilized in the past few data years because of modifications in diagnostic criteria. (more…)
Author Interviews, Technology / 06.01.2017

MedicalResearch.com Interview with: Lukas Bereuter, PhD Candidate University of Bern ARTORG Center for Biomedical Engineering Research Bern, Switzerland MedicalResearch.com: What is the background for this study? What are the main findings? Response: Today, most electronic implants are powered by primary batteries. After battery depletion, the whole implant has to be replaced by a surgery. This causes repeated interventions in a patients’ life, which bears the risk of complications and is costly. To overcome this problem, several groups presented prototypes of implants that are powered by solar cells that are implanted under the skin. However, precise knowledge of the actual light exposure and expectable power output of such an implant in everyday life was lacking so far. With this study, we investigated the real-life feasibility of a solar-powered implant for the first time. For this, we developed portable light measurement devices that feature solar cells and continuously measure a subcutaneous solar cell’s output power when powered by AGM Solar Batteries. The measurement devices were worn by volunteers in their daily routine in summer, autumn and winter. The study showed, that subcutaneously implanted solar cells could generate enough power in everyday-life to fully power e.g. a cardiac pacemaker. (more…)
Author Interviews, Cancer Research, JAMA, Orthopedics / 06.01.2017

MedicalResearch.com Interview with: Charles L. Shapiro, MD Professor of Medicine Co-Director of Dubin Breast Center Director of Translational Breast Cancer Research Director of Cancer Survivorship, Tisch Cancer Institute Mount Sinai Health System Division of Hematology / Medical Oncology: Tisch Cancer Institute New York, NY 10029 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Metastases to bone are frequent in many cancers and cause pain, pathological fractures, necessitate surgical and/or radiation treatments, cause spinal chord compression that can lead to paralysis, and significantly increase health care costs. Zoledronic acid, a bisphosphonate that inhibits bone resorption, is used in standard practice because it reduces the risks skeletal-related events including cancer-related pathological fractures, the need for surgery and/or radiation to bone metastases, and spinal chord compression in patients with breast cancer, prostate cancer and multiple myeloma. However, the optimal dosing interval for zoledronic acid is unknown and based on prior studies and empiricism it is administered monthly along with anti-cancer treatments. In this trial, over 1800 breast cancer, prostate cancer and multiple myeloma patients with bone metastases were randomized to the standard dosing interval of monthly zoledronic acid versus every 3-months zoledronic acid for a duration of two years. The results overall, and in each specific disease site, show that giving zoledronic acid once every 3-months as opposed to monthly did not result in any increase in skeletal-related events. (more…)
Accidents & Violence, Author Interviews / 06.01.2017

MedicalResearch.com Interview with: Emma E. McGinty, PhD, MS Center for Injury Research and Policy and Center for Mental Health and Addiction Policy Research, Department of Health Policy and Management Johns Hopkins Bloomberg School of Public Health Baltimore MD 21205 MedicalResearch.com: What is the background for this study? What are the main findings? Response: All states in the US have some kind of ignition interlock lock, but until this study we didn’t know whether these laws meet their intended goal – to reduce alcohol-involved fatal crashes. Specifically, we lacked evidence on the effectiveness of two different types of interlock laws – mandatory interlock laws, which require all individuals convicted of driving under the influence of alcohol to install an interlock, and partial interlock laws, which require some segments of high-risk DUI offenders – like repeat offenders or those convicted of driving with a very high blood alcohol content – to use an interlock in order to drive legally. (more…)
Author Interviews, Cost of Health Care, JAMA, Medicare, Orthopedics, University of Pennsylvania / 06.01.2017

MedicalResearch.com Interview with: Amol Navathe, MD PhD University of Pennsylvania Staff Physician, CHERP, Philadelphia VA Medical Center Assistant Professor of Medicine and Health Policy, Perelman School of Medicine Senior Fellow, Leonard Davis Institute of Health Economics, The Wharton School Co-Editor-in-Chief, HealthCare: the Journal of Delivery Science and Innovation MedicalResearch.com: What is the background for this study? Response: Bundled payments pay a fixed price for an episode of services that starts at hospital admission (in this case for joint replacement surgery) and extends 30-90 days post discharge (30 days in this study). This includes physician fees, other provider services (e.g. physical therapy), and additional acute hospital care (hospital admissions) in that 30 day window. (more…)
Author Interviews, Memory, Pediatrics / 06.01.2017

MedicalResearch.com Interview with: Dr. Shelley Gray PhD Professor, Speech and Hearing Department of Speech and Hearing Science Arizona State University Tempe, AZ MedicalResearch.com: What is the background for this study? Response: Working memory is the part of our human memory system that simultaneously processes and stores incoming information. It is important to understand the structure of working memory so that more tailored assessments and interventions can be developed to help children with poor working memory learn more successfully. In this study we tested four competing models of working memory in second grade students with typical development using the Comprehensive Assessment Battery for Children – Working Memory (CABC-WM; Gray, Alt, Hogan, Green, & Cowan, n.d.; Cabbage et al., in press). (more…)
Author Interviews, Nutrition, Weight Research / 06.01.2017

MedicalResearch.com Interview with: Dr Stacey Lockyer BSc(hons) MSc PhD RNutr Nutrition Scientist British Nutrition Foundation Imperial House 6th Floor London MedicalResearch.com: What is the background for this study? What are the main findings? Response: This in depth review examines the potential health benefits of resistant starch, a form of starch that is not digested in the small intestine and is therefore considered a type of dietary fibre. Some forms of resistant starch occur naturally in foods such as bananas, potatoes, grains, and pulses, and some are produced or modified commercially and incorporated into food products as a functional ingredient. There has been increasing research interest in resistant starch, with a large number of human studies published over the last 10 years looking at a variety of different health outcomes such as postprandial glycaemia, satiety and gut health. The review summarises reported effects and explores the potential mechanisms of action that underpin them. There is consistent evidence that consumption of resistant starch in place of digestible carbohydrates can aid blood glucose control and this has resulted in an approved health claim in the European Union. There is also some evidence that resistant starch can support gut health and enhance satiety, though much more research is needed in these areas. (more…)
Asthma, Author Interviews, Fish, NEJM, Pediatrics / 06.01.2017

MedicalResearch.com Interview with: Hans Bisgaard, M.D., D.M.Sc. COPSAC, Herlev and Gentofte Hospital University of Copenhagen Copenhagen, Denmark MedicalResearch.com: What is the background for this study? Response: Asthma and lower respiratory infections are leading causes of morbidity and mortality in pediatric populations. Thus, having low cost, effective, safe options for prevention could have important implications for both clinical practice and public health. The increased use of vegetable oils in cooking and of grain in the feeding of livestock has resulted in an increase in the intake of n−6 polyunsaturated fatty acids and a decrease in the intake of n−3 polyunsaturated fatty acids, especially the long-chain poly-unsaturated fatty acids (LCPUFAs) — eicosapentaenoic acid (20:5n–3, EPA) and docosahexaenoic acid (22:6n–3, DHA) — found in cold-water fish. N3-LCPUFAs are known to have immune-modulatory effects, and observational studies have suggested an association between a diet that is deficient in n−3 LCPUFA during pregnancy and an increased risk of asthma and wheezing disorders in offspring. Only a few randomized, controlled trials of n−3 LCPUFA supplementation during pregnancy have been performed and these have generally been underpowered and produced ambiguous results. Therefore, we conducted a double-blind, randomized, controlled trial of n−3 LCPUFA supplementation during the third trimester of pregnancy in a total of 736 Danish women to assess the effect on the risk of persistent wheeze and asthma in offspring. The clinical follow-up rate among children was 96% (N=664) by the end of the 3 years double-blind period and 93% (N=647) after an additional follow-up to age 5 years. (more…)
Author Interviews, JAMA, Mental Health Research, Pulmonary Disease / 06.01.2017

MedicalResearch.com Interview with: Meng-Ting Wang, PhD Associate Professor School of Pharmacy National Defense Medical Center Taipei, Taiwan MedicalResearch.com: What is the background for this study? Response: During the past decades, there have been multiple case reports about acute respiratory distress or acute respiratory failure (ARF) from the use of antipsychotics. Nevertheless, no population-based studies have been conducted to examine this potential drug safety issue. We aimed to investigate the association between use of antipsychotics and risk of ARF in a population of chronic obstructive pulmonary disease (COPD), who is vulnerable to ARF and frequently prescribed with antipsychotics. (more…)
Author Interviews, Neurological Disorders, Radiology / 06.01.2017

MedicalResearch.com Interview with: Jay Desai, M.D. Neurologist, Children’s Hospital Los Angeles Assistant Professor, Keck School of Medicine of USC MedicalResearch.com: What is the background for this study? What are the main findings? Response: We obtained measures of blood flow at rest from all regions of brain using an MRI technique called pulsed arterial spin labeling in 26 participants (children and adults) with stuttering. We compared these blood flow measures with those from 36 fluent controls. We found decreased blood flow in Broca’s region in participants with stuttering when compared to the fluent controls. The amount of blood flow correlated inversely with the severity of stuttering and these findings extended into other portions of the language loop. We also detected alterations in blood flow in other brain regions including superior frontal gyrus, cerebellar nuclei and parietal cortex. (more…)
Author Interviews, OBGYNE, Pediatrics, Pediatrics, Weight Research / 06.01.2017

MedicalResearch.com Interview with: Edwina Yeung, Ph.D Investigator, Division of Intramural Population Health Research Eunice Kennedy Shriver National Institute of Child Health and Human Development MedicalResearch.com: What is the background for this study? Response: About 1 in 5 pregnant women in the United States is obese. Other studies have looked at mothers’ obesity in terms of children’s development, but no U.S. studies have looked at whether there might be a contribution from the father’s weight. MedicalResearch.com: What are the main findings? Response: One of the main findings of this study is that maternal obesity is associated with a delay in fine motor skill-- the ability to control movement of small muscles, such as those in the fingers and hands. Paternal obesity is associated with a delay in personal-social skills including the way the child interacts with others. Having both a mother and a father with severe obesity (BMI≥35) was associated with a delay in problem solving ability. (more…)
Author Interviews, Autism, Gastrointestinal Disease, Psychological Science / 05.01.2017

MedicalResearch.com Interview with: David Q. Beversdor MD Center for Translational Neuroscience University Hospital University of Missouri Health System Columbia, MO 65212 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Altered stress reactivity, alterations in cytokines and a high incidence of gastrointestinal disturbances have all been observed in autism spectrum disorder (ASD). We wished to examine the interactions between these factors. What we found was that patients with greater stress reactivity, as indicated by cortisol response in the testing environment, had greater symptomatology involving the lower gastrointestinal tract, which was predominated by constipation. (more…)
Allergies, Author Interviews, NIH, Pediatrics / 05.01.2017

MedicalResearch.com Interview with: Anna Nowak-Wegrzyn, MD Associate Professor of Pediatrics Icahn School of Medicine at Mount Sinai Jaffe Food Allergy Institute New York, NY 10029 MedicalResearch.com: What is the background for this study? Response: Peanut allergy can be fatal, is usually life-long and has no cure. Considering a dramatic increase in prevalence of peanut allergy over the past decades, affecting estimated 2-3% of infants and young children in the US, there is a dire need for prevention. Prior studies determined that risk of peanut allergy is highest in the infants with severe eczema, those with mutations in filaggrin gene resulting in an impaired skin barrier function and those not eating peanut but exposed to peanut in the household dust. In addition, the prevalence of peanut allergy was 10-fold higher among Jewish children in the United Kingdom compared with Israeli children of similar ancestry. In Israel, peanut-containing foods are usually introduced in the diet when infants are approximately 7 months of age and consumed in substantial amounts, whereas in the United Kingdom children do not typically consume any peanut-containing foods during their first year of life. Based on these observations, a landmark clinical trial (Learning Early about Peanut Allergy, LEAP) has been designed to evaluate whether early introduction of peanut into the diet of infant considered at high risk for peanut allergy can reduce the risk of peanut allergy compared to avoidance of peanut. LEAP and other studies suggested that peanut allergy can be prevented by introduction of peanut-containing foods in infancy. The overall reduction in peanut allergy among the infants in the LEAP trial randomized to an early introduction group compared to those who avoided peanut until age 5 years was 81%. (more…)
Author Interviews, Cost of Health Care, Diabetes, JAMA / 05.01.2017

MedicalResearch.com Interview with: Joseph Dieleman, PhD Institute for Health Metrics and Evaluation University of Washington Seattle, WA 98121 MedicalResearch.com: What is the background for this study? What are the main findings? Response: The objective of this study was to provide a estimate of total health care spending in the United States for an exhaustive list of health conditions, over an extended period of time – from 1996 to 2013. The study primarily focuses on personal health spending, which includes both individual out-of-pocket costs as well as spending by private and government insurance programs on care provided in inpatient and outpatient facilities, emergency departments, nursing care facilities, dentist offices, and also on pharmaceuticals. There were 155 conditions included in the analysis, and spending was also disaggregated by type of care, and age and sex of the patient. In 2013, we accounted for $2.1 trillion in personal health spending in the U.S. It was discovered that just 20 health conditions made up more than half of all dollars spent on health care in the U.S. in 2013, and spending for each condition varied by age, sex and type of care. Diabetes was the most expensive condition, totaling $101 billion in diagnoses and treatments, growing at an alarmingly rate – a 6.5% increase per year on average. Ischemic heart disease, the number one killer in the U.S., ranked the second most expensive at $88.1 billion, followed by low back and neck pain at $87.6, treatment of hypertension at $83.9 billion, and injury from falls at $76.3. Women aged 85 and older spent the most per person in 2013, at more than $31,000 per person. More than half of this spending (58%) occurred in nursing facilities, while 20% was expended on cardiovascular diseases, 10% on Alzheimer’s disease, and 7% on falls. Men ages 85 and older spent $24,000 per person in 2013, with only 37% on nursing facilities, largely because women live longer and men more often have a partner at home to provide care. (more…)
Author Interviews, JAMA, Kidney Disease, Pediatrics / 05.01.2017

MedicalResearch.com Interview with: Jonathan Slaughter, MD, MPH Assistant Professor of Pediatrics Center for Perinatal Research Nationwide Children's Hospital/The Ohio State University Columbus, OH 43205 MedicalResearch.com: What are the main findings? Response: The ductus arteriosus, a fetal blood vessel that limits blood flow through the lungs, normally closes shortly after birth. However, the ductus often remains open in premature infants, leading to patent ductus arteriosus (PDA). Infants with PDA are more likely to die or develop bronchopulmonary dysplasia (BPD), the major chronic lung disease of preterm infants. Nonsteroidal Anti-inflammatory Drug (NSAID) treatment has been shown to close PDAs in preterm infants and NSAID treatment of PDA is common. However, it has never been shown that PDA closure with NSAIDs leads to decreased mortality or improved long-term respiratory outcomes. NSAID closure of PDA has become increasingly controversial in recent years since NSAID treatment has been associated with acute renal injury. Also, these medications are expensive, with the usual three-dose treatment course costing well over $1000 per patient. Due to these controversies, the likelihood of a preterm infant with PDA being treated with NSAIDs varies by clinician and institution and has decreased over time. Meta-analyses of randomized trials that investigated NSAID (indomethacin and/or ibuprofen) treatment for PDA closure in preterm infants did not show a benefit. However, they were principally designed only to study whether the ductus itself closed following treatment and not to determine if there was an improvement in mortality risk or in respiratory outcomes following NSAID treatment. Given the difficulty of conducting randomized trials in preterm infants and the urgent need for practicing clinician's to know whether treatment of PDA in all preterm infants is beneficial, we used a study design that incorporated the naturally occurring practice variation in NSAID treatment for PDA as a mechanism to reduce the risk of biases that are commonly found in non-randomized investigations. This is based on the premise that if NSAID treatment for PDA in preterm infants is truly effective, we should expect to see improved mortality and respiratory outcomes in instances when clinician preference-based NSAID administration rates are higher. (more…)
Alzheimer's - Dementia, Author Interviews, Cognitive Issues, Environmental Risks, Lancet / 05.01.2017

MedicalResearch.com Interview with: Hong Chen, PhD Scientist, Environmental Health Assessment Public Health Ontario | Santé publique Ontario Assistant Professor, Dalla Lana School of Public Health University of Toronto Adjunct Scientist, Institute for Clinical Evaluative Sciences Toronto, ON MedicalResearch.com: What is the background for this study? Response: Over the past several decades, there is unequivocal evidence that living close to major roadways may lead to various adverse health outcomes, such as cardio-respiratory related mortality and mortality. In the past decade, concern is growing that exposures associated with traffic such as air pollution and noise may also have an adverse impact on brain health. Several experimental studies show that air pollutants and diesel exhaust induce oxidative stress and neuroinflammation, activate microglia (which act as the first and main form of immune defense in the central nervous system), and stimulate neural antibodies. There are also a small number of epidemiological studies linking traffic-related noise and air pollution to cognitive decline and increased incidence of Parkinson’s disease and Alzheimer’s disease. Studies also showed that living near roads was associated with reduced white matter hyperintensity volume and cognition, but its effect on the incidence of dementia, Parkinson’s disease, and multiple sclerosis is unknown. Given hundreds of millions of people worldwide live close to major roads, we conducted this population-based cohort study to investigate the association between residential proximity to major roadways and the incidence of these three neurological diseases in Ontario, Canada. (more…)
Author Interviews, Heart Disease, HIV / 05.01.2017

MedicalResearch.com Interview with: Heidi M. Crane MD, MPH Associate Professor of Medicine Associate Director Clinical Epidemiology and Health Services Research Core Center for AIDS Research University of Washington MedicalResearch.com: What is the background for this study? What are the main findings? Response: Studies have suggested that rates of myocardial infarction (MI) are higher in those with HIV, likely for a variety of reasons. However, prior studies have not been able to distinguish MIs by type. The Universal Definition of MI has been recommended by cardiology societies and classifies MIs into types with Type 1 MIs resulting spontaneously from atherosclerotic plaque instability and Type 2 MIs occurring secondary to causes other than atherosclerotic plaque rupture, including hypotension, hypoxia, and stimulant induced spasm resulting in increased oxygen demand or decreased supply. Understanding MI types is likely important as they may indicate a different prognosis and need for different prevention approaches. (more…)
Author Interviews, Boehringer Ingelheim, Dermatology / 05.01.2017

MedicalResearch.com Interview with: Andrew Blauvelt, M.D., M.B.A. President and Investigator Oregon Medical Research Center Portland, OR 97223 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Findings from the guselkumab Phase 3 VOYAGE 1 study showed that patients with moderate to severe plaque psoriasis receiving the anti-interleukin (IL)-23 monoclonal antibody (mAb) achieved significant improvements in skin clearance compared with patients receiving placebo and patients receiving Humira® (adalimumab), a TNF blocker. The Phase 3 study and head-to-head analysis of guselkumab vs. adalimumab in the treatment of moderate to severe plaque psoriasis also showed the significant efficacy of guselkumab maintained through week 48 compared with adalimumab, and the robust efficacy of guselkumab in meeting all primary and major secondary endpoints. (more…)
Author Interviews, Gastrointestinal Disease, Hepatitis - Liver Disease / 05.01.2017

MedicalResearch.com Interview with: Paul Y. Kwo, MD, FACG Stanford University School of Medicine MedicalResearch.com: What is the background for this study? Response: This guideline, which was jointly authored by Drs. Kwo, Cohen, and Lim provides a framework for physicians to approach the very common problem encountered of a patient whose liver chemistries are abnormal. This is particularly relevant as there remain large pools of individuals who have yet to be diagnosed with chronic hepatitis B and C, non-alcoholic fatty liver disease, advanced liver disease as well as less common conditions, all of whom will require evaluation. In particular, the rise in the prevalence of non-alcoholic fatty liver disease worldwide will be addressed in part by identifying and evaluating these individuals prior to the development of advanced fibrosis. The guideline takes clinicians through a step-wise approach to the evaluation of elevated aminotransferase (ALT and AST), alkaline phosphatase, and bilirubin levels including appropriate historical questions, important physical examination findings, laboratory , radiological evaluation and finally liver biopsy if required. (more…)