Author Interviews, BMJ, Karolinski Institute, Mental Health Research, Schizophrenia / 16.03.2016

MedicalResearch.com Interview with: Anna-Clara Hollander PhD Division of Social Medicine, Department of Public Health Sciences Karolinska Institutet, Stockholm, Sweden. MedicalResearch.com: What is the background for this study? What are the main findings? Response: The humanitarian crises in Europe, the Middle East, north Africa, and central Asia have led to more displaced people, asylum seekers, and refugees worldwide than at any time since the second world war. Refugees are known to be at an increased risk of mental health problems, such as post-traumatic stress disorder and other common mental disorders, compared to non-refugee migrants, but little is known about their risk of psychosis. The aim of the study was to determine the risk of schizophrenia and other non-affective psychotic disorders among refugees, compared to non-refugee migrants, and the general Swedish population. We used a linked national register data to examine more than 1.3 million people in Sweden, and tracked diagnoses of non-affective psychotic disorders among the population. The cohort included people born to two Swedish-born parents, refugees, and non-refugee migrants from the four major refugee generating regions: the Middle East and north Africa, sub-Saharan Africa, Asia, Eastern Europe and Russia. Results showed 3,704 cases of non-affective psychotic disorders during the 8.9 million person years of follow up. Refugees granted asylum were on average 66% more likely to develop schizophrenia or another non-affective psychotic disorder than non-refugee migrants. In addition, they were up to 3.6 times more likely to do so than the Swedish-born population. Incidence rates for non-affective psychosis were 385 per million in those born in Sweden, 804 per million in non-refugee migrants, and 1264 per million in refugees. The increased rate in refugees was significant for all areas of origin except sub-Saharan Africa, for whom rates in both groups were similarly high relative to the Swedish-born population. One possible explanation is that a larger proportion of sub-Saharan Africa immigrants will have been exposed to deleterious psychosocial adversities before emigration, irrespective of refugee status. Alternatively post-migratory factors, such as discrimination, racism, and social exclusion may explain these high rates. Overall, our findings are consistent with the hypothesis that increased risk of non-affective psychotic disorders among immigrants is due to a higher frequency of exposure to social adversity before migration, including the effects of war, violence, or persecution. (more…)
Annals Internal Medicine, Author Interviews, Flu - Influenza, Kaiser Permanente, Surgical Research, Vaccine Studies / 16.03.2016

MedicalResearch.com Interview with: Sara Y. Tartof, PhD, MPH Kaiser Permanente Southern California Department of Research & Evaluation MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Tartof: The flu is a highly contagious respiratory infection that can cause serious complications, hospitalizations and, in some cases, even death. Some people, such as older adults, young children and people with certain health conditions, are at high risk for serious complications. In addition to recommending annual flu vaccination for people 6 months of age and older, the Centers for Disease Control and Prevention recommends that hospitalized patients who are eligible receive the flu vaccine before discharge. Historically, inpatient rates of vaccination have been low. There has been concern among surgeons that vaccinating patients while they are in the hospital can contribute to increased risk of vaccine-related fever or muscle pain, which might be incorrectly attributed to surgical complications. However, there have been no data to support that concern. The objective of this study was to provide clinical evidence that would either substantiate or refute concerns about the safety of perioperative vaccination. (more…)
Author Interviews, Lifestyle & Health / 16.03.2016

MedicalResearch.com Interview with: Dr Nipun Shrestha MBBS, MPH Health Research and Social Development Forum Thapathali, Kathmandu, Nepal MedicalResearch.com: What is the background for this study? What are the main findings? Response: These days our work in the offices isn't the same as it used to be. Almost everybody is working with a computer nowadays and that makes you sit still all day. We do not need to move from our chair to do most of the things. This is not just the case in developed countries but for developing countries as well. One would argue though we are sitting in the office hours but we are regularly doing lots of exercises. However researchers have found that sedentary behavior is an independent risk factor for many chronic diseases like diabetes, cardiovascular diseases and cancer. So breaking up time that we spend sitting is important. There are many commercial innovations available in the market which are being advertised heavily by the manufacturers. The evidence on effectiveness of such innovation is however not available. We found that there is limited evidence on effectiveness of interventions that aim to reduce sitting at work. There is some evidence that sit-stand desk may reduce sitting at work between 30 minutes to 2 hours without any adverse effects. (more…)
Author Interviews, Urinary Tract Infections / 16.03.2016

MedicalResearch.com Interview with: Maureen Maurer, MS  American Institute for Research Makawao, HI   MedicalResearch.com: What is the background for this study? Response: Complications from UTIs are a serious medical problem for many people with neurological impairment such as spinal cord injuries. Detection is often difficult in these patients, resulting in delayed diagnosis and more serious infections such as pyelonephritis and sepsis.  UTIs are also the most common hospital acquired infection for all patients. Given the prevalence of UTIs, their complications, and increasing drug therapy resistance, improved early detection methods are needed. The olfactory acuity of dogs is over 100,000 times stronger than humans. Dogs’ superior olfactory capabilities have been employed to assist humans by detecting bombs, drugs, and more recently, cancer. Trained dogs may present a novel method for early UTI detection. Our objective was to determine whether canines could be trained to discriminate culture-positive from culture-negative urine samples.  (more…)
Author Interviews, Electronic Records, JAMA, Primary Care / 16.03.2016

MedicalResearch.com Interview with: Daniel R. Murphy MD MBA Assistant Professor - Interim Director of GIM at Baylor Clinic Department of Medicine Health Svc Research & General Internal Medicine Baylor College of Medicine Houston, TX, US MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Murphy: Electronic health records (EHRs) have enabled a large number of messages to be transmitted to physicians each day, including new types of messages that were not present in the pre-EHR era. Lack of support and policies to assist physicians with this workload creates opportunities for important information, such as abnormal tests results, to be missed among the vast amount of other information. We found that primary care physicians (PCPs) at three clinics using commercial EHRs received an average of 77 messages per day, of which only about 20% were test results. Specialists received an average of 29 total messages per day. Extrapolating time needed to process these messages from prior work suggests that PCPs would require an average of 67 minutes per day to process these messages. (more…)
Author Interviews, OBGYNE, Pediatrics, PLoS, Surgical Research / 16.03.2016

MedicalResearch.com Interview with: Dr Mairead Black MBChB, MRCOG, MSc Clinical Lecturer, Obstetrics and Gynaecology School of Medicine and Dentistry, Division of Applied Health Sciences University of Aberdeen Aberdeen Maternity Hospital, Cornhill Road Aberdeen MedicalResearch.com: What is the background for this study? Dr. Black: The commonest reason for performing a planned Cesarean Section (CS) in high-income countries is a history of a previous CS. However, there is very little information available on childhood health outcomes of birth after a previous . MedicalResearch.com: Why might vaginal birth be beneficial? Dr. Black: If a baby is born naturally, it is exposed to various processes of labour and birth which may help their immunity and ability to avoid or fight future illness. (more…)
Author Interviews, Heart Disease / 15.03.2016

MedicalResearch.com Interview with: Michael D. Miedema, MD, MPH Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis, MN MedicalResearch.com: What is the background for this study? Dr. Miedema: Heart disease is the leading cause of death in the United States. With increasing risk factors like obesity and diabetes more population level prevention efforts are needed. Heart of New Um Project (HONU) was created as a demonstration project to test prevention of cardiovascular disease by reducing modifiable risk factors across the entire community. HONU interventions focus on improving health by reaching individuals in health care, worksites, and the community settings but also creating healthier environment and a social movement around being healthy to enable individuals to make healthier choices. Example interventions in health care, worksite, and the broader community include:
  • Health care: Comprehensive free heart health screening held every few years to identify risks (results shared with providers and follow up was done in clinics to address medication needs). We also used the electronic health record to apply some algorithms to calculate risk of heart disease and were able to offer health coaching to people who did not yet have heart disease or diabetes but who were at high risk.
  • Worksites:  we developed and partnered with over 40 worksites in the community to conduct health screenings of employees, to identify ways companies could improve their wellness policies, and offering onsite behavior change programs.
  • Community: work with restaurants to improve healthy options, increasing farmers market participation by farmers and by consumers, creating run/walk events, community wide health challenges, and creating a social movement through social marketing and community organizing.
(more…)
Author Interviews, JAMA, Johns Hopkins, Surgical Research / 15.03.2016

MedicalResearch.com Interview with: Shaun C. Desai, MD Assistant Professor Facial Plastic and Reconstructive Surgery Department of Otolaryngology - Head & Neck Surgery Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Desai: Estimates of the rate of revision septorhinoplasty and the risk factors associated with revision are unknown because the current published literature is limited to small, retrospective, single-surgeon studies with limited follow-up time. The purpose of this study is to determine the overall revision rates of patients undergoing a septorhinoplasty procedure (for functional or cosmetic reasons) and to determine risk factors for the revision. We found that the overall revision rate was 3.3% (5,775 patients of a total of 175,842 patients undergoing the procedure) with an average time to revision at 1 year. Risk factors for revision surgery included female gender, younger age, a history of anxiety or autoimmune disease, cosmetic indications, and more complicated initial surgery (i.e. cleft rhinoplasty). (more…)
Author Interviews, Heart Disease, Stem Cells / 15.03.2016

MedicalResearch.com Interview with: Joost P.G. Sluijter, PhD, FESC Associate Professor Department of Cardiology Experimental Cardiology Laboratory UMC Utrecht MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Sluijter: Cell transplantation therapy for ischemic heart disease has entered the arena of clinical trials more than a decade ago. Multiple cell types have been used since these first endeavors, and there is accumulating evidence that different cell types positively influence the damaged heart through paracrine and/or regenerative mechanisms. One of the most promising cell types to be used are the cardiac-located stem cells. Cardiac stem cells (CSCs) have been found to reside in the adult heart and can differentiate towards all cell types that are needed in the normal functional heart. These cells have shown great potential as a regenerative therapeutic upon myocardial infarction (MI) in animal models and are currently being tested in some clinical studies. However, although promising, no systematic overview and subsequent meta-analysis of preclinical data exists to date for this cell type and if they are consistently effective. Our systematic approach, yielded 80 studies and included over 1900 animals, confirms the consistent effect of CSCs and provides us with a first comprehensive overview of pre-clinical MI studies in an unbiased and systematic manner.  Nowadays we are aware of a failure in therapeutic effect size for the translation axis, where we try to bridge fundamental findings from the lab to the bedside. This means that effects we observe in our initial studies on cardiac performance are slowly getting less successful when we are getting closer to a real clinical scenario. Through our meta-analysis, we observed a consistent therapeutic effect of Cardiac stem cells therapy on cardiac function after MI, where 12% of functional improvements is observed in rodents, and only an 8% improvement was still present in large animal models. From previous observations, we know that this leaves a 3-4% of effect in a patient population. In addition to the difference in effect size between small and large animal models, also a difference in study quality and attrition bias was observed. Interestingly, although additional support to the idea that Cardiac stem cells are efficacious in preclinical studies were observed, we did not find any influence of immunosuppression, cell source, comorbidity of CSC donors, culture methods, or model of ischemia on the outcomes. (more…)
Annals Internal Medicine, Author Interviews, Smoking / 15.03.2016

MedicalResearch.com Interview with: Dr Nicola Lindson-Hawley PhD Cochrane Tobacco Addiction Group (TAG) Managing Editor MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Lindson-Hawley: For many people, the obvious way to quit smoking is to cut down gradually until they stop.  After all, that’s how we accomplish most other goals that are hard.  With addictions other than smoking, we aim to get people to cut down gradually rather than stop abruptly.  But with smoking, the norm is to advise people to stop all at once.  Around the world, physicians and others who support smoking cessation help people to quit abruptly and not to cut down first.  However, if physicians are not providing support to people who want to quit by reduction, then they will have less chance of success as we know that people who receive support to quit are more likely to succeed.  On the other hand, if cutting down is a bad way to quit, then we need to persuade people to abandon their common sense idea and quit abruptly instead. Therefore, this study investigated this by comparing a group of smokers advised to quit gradually by cutting down with a group who quit all at once. What we found was that cutting down first, was a less successful way to quit than smoking as normal and then stopping. Smokers who quit abruptly were 25% more likely to have quit after 4 weeks than those who quit gradually. (more…)
Author Interviews, BMJ / 15.03.2016

MedicalResearch.com Interview with: Sílvia Mamede, MD, PhD Associate professor Institute of Medical Education Research Rotterdam Erasmus MC Rotterdam, The Netherlands MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Mamede: Doctors are often engaged in clinical encounters that are emotionally charged. Patients who feel anxious about their problems often respond emotionally in their interaction with their doctors. Most of these encounters fall within the limits of what is to be expected in clinical practice, but some patients behave in ways that make the doctor-patient interaction particularly distressing. Aggressive or disrespectful patients, frequent demanders, patients who don’t trust their doctors’ competence or ever-helpless patients are known, in the medical literature, as “difficult patients”. Doctors have reported to encounter these so-called “difficult patients” in around 15% of the outpatient consultations. As it might be expected, these patients’ behaviors provoke emotional reactions in doctors. The potential negative effect of these reactions on the doctor’s diagnostic accuracy has long been discussed in the medical literature. However, there was no empirical evidence that this happened. We conducted two studies to fill this gap. In the two studies, doctors diagnosed clinical cases that were exactly the same except for the patient’s behaviors. In the first study, we used complex and simple cases. Even though the cases were the same, doctors made 42% more mistakes in disruptive than in non-disruptive patients when the cases were complex, and 6% more mistakes when the cases were simple. In the second study, we used cases deemed to be at an intermediate level of complexity. Doctors made 20% more mistakes in difficult compared to neutral patients. These findings show that disruptive behaviors displayed by patients seem to affect doctors’ reasoning and induce them to make diagnostic errors. The findings of our second study suggest that disruptive behaviors “capture” the doctor’s attention at the expense of attention for the clinically relevant information. We came to this conclusion because when asked to recall the information from a case afterwards, doctors who were confronted with a difficult patient remember more information about the patient’s behaviors and less information of the clinically relevant symptoms than doctors confronted with the natural version of the same patient. Recall of information is considered a measure of the amount of attention given to such information. (more…)
Aging, Author Interviews, Lifestyle & Health / 15.03.2016

MedicalResearch.com Interview with: Ding Ding (Melody), Ph.D., MPH NHMRC Early Career Senior Research Fellow/Sydney University Postdoctoral Research Fellow Prevention Research Collaboration Sydney School of Public Health The University of Sydney MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Ding: This study used data from the Sax Institute’s 45 and Up Study, a large Australia based cohort of adults aged 45 or older. We followed around 25,000 participants who were working at baseline (2006-2008) for an average of 3 years (follow-up in 2010). During the follow-up period, around 3,000 participants retired from the workforce. Participants were asked to report their health-related lifestyle behaviors, such as physical activity, smoking, and sleep time at both baseline and follow-up. We found that those who retired overall had significant improvement in their lifestyle as compared with those who did not, including more physical activity, less sitting time, and more sleep. Female smokers who retired were also more likely to have quit smoking. (more…)
Author Interviews, Diabetes, Pulmonary Disease, Sleep Disorders / 15.03.2016

MedicalResearch.com Interview with: Jonathan Shaw MD, FRACP, FRCP (UK), FAAHMS Associate Professor Domain Head, Population Health Research Baker IDI Heart and Diabetes Institute Melbourne VIC 3004 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Shaw: Over the last decade or so, there has been a lot of research connecting obstructive sleep apnoea with type 2 diabetes. They co-exist very frequently in the same individual, they are both much more common in overweight and obese people than in people of healthy weights, both improve with weight loss, and both are associated with other conditions such as hypertension and heart disease. In addition, there has been evidence that some of the key abnormalities occurring in sleep apnoea (in particular, fragmented sleep and intermittent low oxygen levels) may have a direct effect on glucose metabolism, and increase blood sugar levels. This led many people to suspect that untreated sleep apnoea might be one reason that type 2 diabetes is hard to control, and that treating sleep apnoea in people with type 2 diabetes would improve their blood sugar control. We, therefore, undertook a large trial among people with type 2 diabetes, and previously unrecognised sleep apnoea, in which participants were randomised to either a group receiving specific treatment for sleep apnoea (continuous positive airways pressure, or CPAP, therapy at night) or to a control group. Over the six months of the trial, we saw no benefit of CPAP therapy in regard to blood sugar control (as measured by HbA1c). Even when we looked at sub-groups with worse blood sugar control at the start or worse sleep apnoea or who did the best in terms of using CPAP every night, there was still no sign of benefit on blood sugar control. We did, however, see some other benefits of CPAP therapy, with less daytime sleepiness, improvements in quality of life and lower diastolic blood pressure. (more…)
Author Interviews, Hand Washing, Hospital Acquired, JAMA, University of Michigan / 15.03.2016

MedicalResearch.com Interview with: Lona Mody, MD, MS Veterans Affairs Healthcare System, Geriatric Research, Education, and Clinical Center Division of Geriatric and Palliative Medicine, University of Michigan Medical School, School of Public Health University of Michigan, Ann Arbor MedicalResearch.com: What is the background for this study? Dr. Mody: Hand hygiene is considered to be the most important strategy to prevent infections and spread of drug resistant organisms. Surprisingly, all strategies and efforts have predominantly involved healthcare workers and that too mainly in acute care hospitals.  We are now facing a tsunami of an aging population in our hospitals, post-acute care facilities and long-term care facilities.  Hand hygiene falls off when patients are hospitalized compared to when they are at home.  So, we were very interested, first, in hand colonization in older patients who have recently been transferred from the acute care hospital to a post-acute care (PAC) facility for rehabilitation or other medical care before fully returning home. We were also interested in evaluating whether these organisms persisted. MedicalResearch.com: What are the main findings? Dr. Mody: We recruited and followed 357 patients (54.9 percent female with an average age of 76 years). The dominant hands of patients were swabbed at baseline when they were first enrolled in a post-acute care facility, at day 14 and then monthly for up to 180 days or until discharge. The study found:
  • To our surprise, nearly one-quarter (86 of 357) of patients had at least one multi-drug resistant organism on their hands when they were transferred from the hospital to the post-acute care facility
  • During follow-up, 34.2 percent of patients’ hands (122 of 357) were colonized with a resistant organism and 10.1 percent of patients (36 of 357) newly acquired one or more resistant organisms.
  • Overall, 67.2 percent of colonized patients (82 of 122) remained colonized at discharge from PAC.
(more…)
Author Interviews, Education, NYU, Pediatrics, PNAS, Weight Research / 15.03.2016

MedicalResearch.com Interview with: Michele Leardo Assistant Director Institute for Education & Social Policy New York University New York, NY 10012 MedicalResearch.com: What is the background for this study? What are the main findings? Response: US school districts increasingly distribute annual fitness and body mass index (BMI) “report cards” to students and parents. Such personalized informational interventions have appeal in economics because they can inform parents about their children's obesity status at relatively low costs. Awareness of the weight status can lead to behavioral responses that can improve health. New York City public schools adopted Fitnessgram in 2007-2008, reporting each student’s BMI alongside categorical BMI designations. We examined how being classified as “overweight” for the previous academic year affected the students’ subsequent BMI and weight. Specifically, we compared female students whose BMI was close to their age-specific cutoff for being considered overweight with those whose BMI narrowly put them in the “healthy” category. We find that being labeled overweight had no beneficial effects on students’ subsequent BMI and weight. (more…)
Author Interviews, BMJ, Gender Differences / 14.03.2016

MedicalResearch.com Interview with: Giovanni Filardo, PhD, MPH Director of Epidemiology, Office of the CQO, Baylor Scott & White Health Briget da Graca, JD, MSSenior Medical Writer Center for Clinical Effectiveness Office of the CQO Baylor Scott & White Health Dallas, Texas MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Filardo: While there are readily available, up-to-date data on the proportion of medical school applicants, graduates, and member of faculty women constitute, no similar information is routinely collected and shared about women’s participation in and leadership of medical research studies. The previous studies looking at this issue were conducted in 2004, and were limited to investigating the proportion of women among the first authors with MD degrees and with institutional affiliations in the United States or United Kingdom. The time was therefore ripe for an updated, rigorous, and comprehensive examination of first authorship in high impact medical journals. We examined female first authorship of original research articles published over the past 20 years in the 6 general medical journals with the highest impact factors: Annals of Internal Medicine (Annals), Archives of Internal Medicine (Archives), The BMJ (formerly the British Medical Journal), Journal of the American Medical Association, The Lancet, and New England Journal of Medicine (NEJM). After adjusting for differences over time and between journals related to different prioritisation of studies according to type, topic/specialty, country in which the research was conducted, or number of listed authors, we found that female first authorship increased overall from 27% in 1994 to 37% in 2014, but had plateaued – and in the cases of The BMJ and NEJM – declined in the last 5 years. Our results also revealed significant differences in female first authorship between journals. (more…)
Author Interviews, Cost of Health Care / 14.03.2016

MedicalResearch.com Interview with: Steffie Woolhandler MD, MPH, FACP and David U. Himmelstein MD, FACP CUNY School of Public Health at Hunter College MedicalResearch.com: What is the background for this study? What are the main findings? Response: The Cadillac Tax aims to eventually eliminate tax subsides to employer-sponsored coverage.  When an employer provides health benefits to an employee, the employee pays no income or FICA tax on the value of those benefits, although the benefits are obviously part of the employee's compensation.  In other words, the taxpayers are currently picking up part of the employee's health insurance costs. Economists and politicians have been justifying the ACA's Cadillac Tax by portraying it as a "Robin Hood" tax that would take from the rich and give to the poor. That view of the Cadillac Tax is untrue.   We found that the main beneficiaries of the current tax subsidies to employer sponsored coverage are middle class families (defined by a family income between $39,000 and $100,000 in 2009 dollars) for whom the subsidies boost their effective income by about 5%.   These middle class people are the ones who would be most harmed when the Cadillac Tax kicks-in and curtails the current tax subsidies. (more…)
Author Interviews, BMJ, Pediatrics / 14.03.2016

MedicalResearch.com Interview with: Ashley Bryce, NIHR PhD student Centre for Academic Primary Care, University of Bristol (first author) Dr Céire Costelloe NIHR Health Protection Research Unit in Healthcare associated infections and AMR, Imperial College London (senior author)  MedicalResearch.com: What is the background for this study? Response: Antimicrobial resistance is an internationally recognised threat to health. Previous antibiotic use has been shown to be a risk factor for antimicrobial resistance in adults. The contribution of primary healthcare is particularly important as this is where almost 80% of all antibiotics used within the health service are prescribed. Children receive a lot of primary healthcare services and, as such, receive a disproportionately high number of antibiotics compared with middle aged populations. Despite this, little research has been published describing the prevalence of bacterial resistance in children or the risk factors of importance in this group. MedicalResearch.com: What are the main findings? Response: Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment. (more…)
AHA Journals, Author Interviews, Heart Disease, McGill / 14.03.2016

MedicalResearch.com Interview with: Dr George Thanassoulis MD MSc FRCPC McGill University Health Center and Research Institute Montreal, Quebec, Canada MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Thanassoulis: Currently statins are recommended in most countries worldwide based on 10-yr risk of heart disease but because age is the best predictor of future heart disease this leads to many more older patients being eligible for statins at the expense of younger people.  This means that even young patients with higher levels of low-density cholesterol, a known cause of heart disease, are not eligible for statins until they are much older.  However, waiting for these individuals to become "old enough for treatment" permits their higher LDL  to continue to damage their arteries leading, in some cases, to advanced coronary disease at the time when statins are finally stated.  So we are missing an opportunity to effectively prevent heart disease. What our analysis shows is that we need to consider not just someone's risk of having a heart attack but also whether they would be expected to benefit from statins.  By integrating information from randomized trials we were able to show that there were over 9.5 million Americans who were at low risk (and not eligible for statin therapy) that would have the same absolute benefit as higher risk people who we currently treat.  These patients, as expected, were younger but had higher levels of LDL cholesterol.  We also showed that statin therapy in these individuals would avoid more than 250,000 cardiac events over 10 years.  (more…)
Author Interviews, Heart Disease / 14.03.2016

MedicalResearch.com Interview with: Prof. Dr. Thomas Pilgrim Inselspital Berne Switzerland  Medical Research: What is the background for this study? Dr. Pilgrim: Long-term prognostic implications of different clinical manifestations of coronary artery disease are insufficiently understood at this time. A time variable pattern of recurrent events following PCI for STEMI, Non-STE-ACS or stable ischemic heart disease may have important implications for medical management and secondary prevention. Medical Research:? What are the main findings? Dr. Pilgrim: In our analysis, we found a differential in timing of ischemic events after PCI according to presentation with STEMI, NSTE-ACS, or stable ischemic heart disease, respectively. While patients with NSTE-ACS were at increased risk of death at any time after PCI as compared to patients with stable ischemic heart disease, patients with STEMI had an increased risk during the first 30 days after PCI but not thereafter compared to patients with stable ischemic heart disease. (more…)
Author Interviews, Blood Pressure - Hypertension, Heart Disease, JAMA, OBGYNE / 14.03.2016

MedicalResearch.com Interview with: Ida Behrens, MD and Heather Boyd PhD Department of Epidemiology Research Statens Serum Institut Copenhagen, Denmark MedicalResearch.com: What is the background for this study? Response: Over the past decade, we have begun to realize that a woman’s pregnancy experiences can be a predictor of her future health. Miscarriages, stillbirths and preterm deliveries have all been linked with an increased risk of later cardiovascular disease, as have hypertensive disorders of pregnancy (preeclampsia and gestational hypertension). Women with preeclampsia also have an increased risk of peripartum cardiomyopathy, a rare but serious condition that severely compromises heart function at the end of pregnancy or shortly after delivery. We were interested to find out whether women with preeclampsia or gestational hypertension during one or more pregnancies also had an increased risk of cardiomyopathy later in life. MedicalResearch.com: What are the main findings? Response: Using Danish national registers, we followed more than 1 million women with pregnancies between 1978 and 2011 – with an average follow-up of almost 18 years per woman – to see whether women with hypertensive disorders of pregnancy had increased rates of cardiomyopathy later in life, compared with women who only had normotensive pregnancies. We found that the women with hypertensive disorders of pregnancy had a two-fold increased risk of cardiomyopathy later in life. Interestingly, only half of this increase in risk could be linked to chronic hypertension, which is common among women who have previously had a hypertensive disorder of pregnancy. The remaining 50% was not associated with hypertension and could potentially be directly attributable to the woman’s pregnancy experience (or to an underlying cause common to both hypertensive disorders of pregnancy and cardiomyopathy).  (more…)
Author Interviews, Breast Cancer / 14.03.2016

MedicalResearch.com Interview with: Professor Nigel Bundred MD, FRCS Professor of Surgical Oncology Institute of Cancer Sciences University Hospital of South Manchester MedicalResearch.com: What is the background for this study? Dr. Bundred: HER-2 is a cancer-causing gene which is expressed in some cells by having more copies of the gene and predicts for early relapse and metastasis from the tumour. Despite this, even in the absence of anything other than local treatment, some 50% of patients still survive for five years without relapse. Herceptin was discovered and licensed for use in 2006 because it improved survival when given with chemotherapy after surgery, from 66% at five years to 90% at five years. The use of Herceptin and chemotherapy before surgery to shrink the tumour indicates that around 30% of patients have a complete pathological response with this treatment. Combination of dual anti-HER-2 therapies and  Neoadjuvant chemotherapy given for six months before surgery has been shown to increase pCR rate to 50% and a single study utilising the combination of pertuzumab and trastuzumab (two anti-HER-2 monoclonal antibodies) given for four months revealed a 16.8% pCR rate. (more…)
AHA Journals, Author Interviews, Exercise - Fitness, Heart Disease / 14.03.2016

MedicalResearch.com Interview with: Pei-JieChen, Ph.D. Professor of Exercise Science, President of Shanghai University of Sport MedicalResearch: What is the background for this study? Dr. Pei-JieChen: Traditional Chinese exercises (such as Tai Chi, Qigong, Baduanjin) have been used for 2000 years with great contributions to human health, which are increasingly popular around the world. And traditional Chinese exercise is a low-risk, promising intervention that could be helpful for improving quality of life and depression in patients with cardiovascular diseases (CVDs).However, there appears to be no consensus agreement that traditional Chinese exercises (TCEs) could be effective for CVDs. Therefore, we performed a systematic review and meta-analysis to estimate the effectiveness of Traditional Chinese exercise for patients with CVDs. MedicalResearch: What are the main findings? Dr. Pei-JieChen: The pooling revealed that TCEs could decrease systolic blood pressure by 9.12 mmHg and diastolic blood pressure by 5.12 mmHg. Patients performing traditional Chinese exercises were also found superior compared with those in the control group in terms of triglyceride, six-minute walk test, Minnesota Living with Heart Failure Questionnaire results, SF-36 physical function, and Profile of Mood States depression. (more…)
Author Interviews, JAMA, Ophthalmology / 14.03.2016

MedicalResearch.com Interview with: Fanny Raguideau Evaluateur en pharmaco-épidémiologie Direction Scientifique et de la Stratégie Européenne Pôle Epidémiologie des produits de santé  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Retinal detachment (RD), including both exudative types often associated with systemic diseases that might be receiving antibiotics for related conditions as well as rhegmatogenous which require prompt surgical intervention to reduce the chance of irreversible severe vision loss, has an annual incidence rate of 1 per 10,000 in the general population. Rhegmatogenous is the most common type. Fluoroquinolones are one of the most commonly prescribed classes of antibiotics. Thanks to their broad-spectrum antibacterial coverage, they are effective in the treatment of a wide variety of community-acquired infections. MedicalResearch.com: What is the background for this study? What are the main findings? Response: Several studies have suggested that oral fluoroquinolone use increased the risk of Retinal detachment, however this association remains controversial. We conducted a nationwide self-matched design study to overcome limitations of previous studies. Our finding of a significant increased risk of  Retinal detachment, including both rhegmatogenous and exudative types, following use of oral fluoroquinolone strongly supports the existence of this association. (more…)
Author Interviews, Cancer, Cancer Research, Cost of Health Care / 14.03.2016

MedicalResearch.com Interview with: Hrishikesh Kale School of Pharmacy Virginia Commonwealth University MedicalResearch.com: What is the background for this study? What are the main findings? Response: The cost of cancer care in the United States is extremely high and escalating every year. Because of increased cost sharing, patients are paying higher out-of-pocket costs for their treatments. Along with high medical expenses, cancer survivors face problems such as loss of employment and reduced productivity. It has been well-established in the literature that because of high out-of-pocket costs, many cancer survivors forgo or delay medical care and mental health-related services and avoid filling prescriptions. This puts their physical and mental health at risk. A related issue is the growing number of cancer survivors in the U.S. As of January 2014, there were approximately 14.5 million cancer survivors in the U.S. By 2024, this number is expected to reach 19 million as a result of improved survival among patients with cancer along with an aging population. Therefore, we decided to investigate the prevalence and sources of financial problems reported by a nationally representative sample of cancer survivors from the 2011 Medical Expenditure Panel Survey. We also studied the impact of cancer-related financial burden on survivors’ health-related quality of life and psychological health. (more…)
Alzheimer's - Dementia, Author Interviews, Exercise - Fitness, Lifestyle & Health / 14.03.2016

MedicalResearch.com Interview with: Cyrus A. Raji, MD, PhD Resident in Diagnostic Radiology UCLA Health System  MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Raji: The purpose of this study was to investigate the relationship between caloric expenditure from leisure physical activities (15 different ones were assessed from walking to gardening to dancing to swimming etc.). Increased caloric expenditure from these physical activities were related to larger gray matter volumes in key brain areas for memory and learning (hippocampus, precuneus) that are also affected by Alzheimer's. These findings were demonstrated in 876 persons who had MRI scans and caloric expenditure assessed. Five years after the scan a subset of 326 persons from the larger group of 876 were followed cognitively and it was found that those with larger gray matter volumes associated with physical activity in the orbital frontal cortex and precuneus had a 2 fold reduction in the risk for cognitive decline to mild cognitive impairment and Alzheimer's dementia.  (more…)
Author Interviews, Infections, OBGYNE, Pediatrics / 14.03.2016

MedicalResearch.com Interview with: Elaine Tuomanen, MD Chair and Full Member Dept of Infectious Diseases St Jude Children’s Research Hospital 262 Danny Thomas Place Memphis, TN 38105 MedicalResearch.com: What is the background for this study? What are the main findings? Dr. Tuomanen: While investigating mechanisms of brain repair during infection in a mouse model system, we found that components from the surfaces of bacteria could traffic from the mother to the fetus. The bacterial components moved across the placenta and into the fetal brain. To our surprise, the fetal brain did not respond with neuronal death like we see in children with meningitis. Rather, fetal neurons proliferated. This response involved the innate immune system (TLR2) inducing the neuronal transcription factor, FoxG1, which is known to drive proliferation. The newly born neurons migrated appropriately to the cortical plate, the area on the surface of the fetal brain that forms the cortex, a major part of the adult brain. Although the neurons moved to the right place in the brain, there were too many and they crowded together in the cortex, changing the architecture of the brain. At birth, affected mice seemed to have no abnormalities. However, when we tested if this change in architecture would affect brain function after birth, mice were shown to progressively develop defects in learning, memory and other cognitive functions. This indicates there is a window during pregnancy where components of bacteria from the mother can change fetal brain architecture and subsequent postnatal behavior (more…)
Allergies, Author Interviews, Immunotherapy / 14.03.2016

MedicalResearch.com Interview with: Stacy L. Rosenberg, MD UPMC Montefiore Allergy and Immunology Fellow MedicalResearch.com: What is the background for this study? Dr. Rosenberg: Allergy shots or allergen immunotherapy (AIT) is an effective therapy for allergic rhinoconjunctivitis (hay fever).  Low adherence has been a significant barrier, whereas rush immunotherapy to environmental allergens provides rapid build-up and offers quicker efficacy, which may improve adherence.  However, there have been concerns for increased risk of systemic reactions with rush protocols.  We describe a new protocol for modified rush AIT that offers quicker build-up towards a maintenance dose with improved safety and lower risk of systemic reactions.  We also hypothesize that there are specific characteristics that distinguish patients who develop systemic reactions in the setting of modified environmental rush immunotherapy (MERIT). MedicalResearch.com: What are the main findings? Dr. Rosenberg: Overall, MERIT has a good safety profile.  A subset of patients did develop systemic reactions, which were mild.  Lower BMI was associated with systemic reactions and there was a trend between history of urticaria (hives) and younger age with development of systemic reactions.  Significantly more patients with systemic reactions had allergen extracts containing cat, dust mite, and weed pollen.  Neither gender, asthma, nor anaphylaxis history were associated with an increased risk of systemic reactions. (more…)