Author Interviews
08 Sep For Kidney Patients, No One Size-Fits-All Treatment For Coronary Artery Disease
MedicalResearch.com Interview with:
Dr.Sripal Bangalore MD, MHA, FACC, FAHA, FSCAI,
Director of Research, Cardiac Catheterization Laboratory,
Director, Cardiovascular Outcomes Group,
Associate Professor of Medicine,
New York University School of Medicine,
New York, NY 10016,
Principal Investigator ISCHEMIA-CKD trial
Medical Research: What is the background for this study? What are the main findings?
Dr. Bangalore: Patients with chronic kidney disease are at high risk of coronary artery disease. However, they are also at risk for worsening kidney function from revascularization procedures and have been routinely excluded from clinical trials of stenting vs bypass surgery. In this registry study of over 5900 patients with multivessel coronary artery disease who underwent bypass surgery or stenting using the latest generation drug eluting stent (everolimus eluting stent), we showed that there are trade off between both procedures. With bypass surgery there was increase in the risk of death, myocardial infarction and stroke in the short term (in-hospital/30-days). For PCI, there was long term risk of repeat revascularization and also increase in myocardial infarction in those who achieved incomplete revascularization.
08 Sep Benefits of Iron Supplementation During Pregnancy Outweighed Malaria Risks
MedicalResearch.com Interview with:
Dr. Martin N. Mwangi
Researcher
Division of Human Nutrition,
Nutrition and Health over the lifecourse
International Nutrition Unit
Wageningen University
The Netherlands
Medical Research: What is the background for this study?
Dr. Mwangi : Anemia in pregnancy is a moderate or severe health problem in more than 80 percent of countries worldwide, but particularly in Africa, where it affects 57 percent of pregnant women. Iron deficiency is the most common cause, but iron supplementation during pregnancy has uncertain health benefits. There is some evidence to suggest that iron supplementation may increase the risk of infectious diseases, including malaria.
Our main objective was to measure the effect of antenatal iron supplementation on maternal Plasmodium infection risk, maternal iron status, and neonatal outcomes. We randomly assigned 470 pregnant Kenyan women living in a malaria endemic area to daily supplementation with 60 mg of iron (n = 237 women) or placebo (n = 233) until 1 month postpartum. All women received 5.7 mg iron/day through flour fortification during intervention and usual intermittent preventive treatment against malaria.
Medical Research: What are the main findings?
Dr. Mwangi : Overall, we found no effect of daily iron supplementation during pregnancy on risk of maternal Plasmodium infection. Iron supplementation resulted in an increased birth weight [5.3 ounces], gestational duration, and neonatal length; enhanced maternal and infant iron stores at 1 month after birth; and a decreased risk of low birth weight (by 58 percent) and prematurity. The effect on birth weight was influenced by initial maternal iron status. Correction of maternal iron deficiency led to an increase in birth weight by [8.4 ounces].
08 Sep Molecular Test For C. difficile Leads To Overdiagnosis
MedicalResearch.com Interview with:
Christopher R. Polage, M. D.
Associate Professor of Pathology and Infectious Diseases
University of California, Davis School of Medicine
Medical Director, Microbiology Laboratory and SARC
UC Davis Health System
Medical Research: What is the background for this study?
Dr. Polage: Clostridium difficile is a frequent cause of diarrhea and infection in U.S. hospitals but common diagnostic tests often disagree about which patients are infected or need treatment. We compared clinical symptoms and outcomes in hospitalized patients with different C. difficile test results to determine which type of test (molecular or PCR test versus toxin test) was the better predictor of need for treatment and disease.
Medical Research: What are the main findings?
Dr. Polage: Twice as many patients were positive by the molecular test versus the conventional toxin test. However, patients with a positive molecular test only had a shorter duration of symptoms than patients with toxins, and outcomes that were similar to patients withoutC. difficile by all test methods. Virtually all traditional complications of C. difficile infection occurred in patients with a positive toxin test; none occurred in patients with a positive molecular test only, despite little or no treatment.
08 Sep Patients Facing Higher Copays For Procedures Choose Cheaper Ambulatory Settings
MedicalResearch.com Interview with:
James C. Robinson PhD MPH
Leonard D. Schaeffer Professor of Health Economics
Director, Berkeley Center for Health Technology
Head, Division of Health Policy & Management
School of Public Health, University of California– Berkeley
University Hall, Berkeley, CA
Medical Research: What is the background for this study? What are the main findings?
Dr. Robinson: Employers and insurers face wide variation in the prices of similar tests and procedures within the same local communities, resulting from the indifference to price on the part of well-insured patients. They are raising deductibles to increase price sensitivity, but deductibles mostly target low-cost primary care services whereas their concerns often center on high-cost specialty and facility services. Some are adopting reference pricing, which sets a maximum insurer contribution for a particular type of test or procedure and then requires consumers selecting more expensive options to pay the difference themselves. The insurers contribution limit typically is set at the median or other midpoint in the market distribution of prices.
We studied the implementation of reference pricing for colonoscopy, using data from the California Public Employees Retirement System (CalPERS) from 2009-13, with a control group from Blue Cross of California. Our data include detailed claims from almost 300,000 colonoscopy procedures and patients. We find that patients who must pay the extra fees themselves are much more likely to select cheaper ambulatory facilities for their colonoscopies, compared to consumers who do not face reference pricing. This leads to lower prices being paid by the employer and significant savings. Detailed analyses of gastroenterological and cardiovascular complications of the colonoscopy procedures found no adverse effect of reference pricing on quality.
08 Sep Denim Sandblasters At High Risk of Pulmonary Silicosis
MedicalResearch.com Interview with: Metin Akgun, MD, FCCP Department of Pulmonary Medicine Atatürk University, Faculty of Medicine Erzurum, Turkey Medical Research: What is the background for this study? What are the main findings? Dr. Akgun: The first cases of silicosis due to denim sandblasting were reported in 2005. In 2007, we evaluated 145 former male denim sandblasters who had an exposure history to at least 1 month with a latency period at least ten months; 77 (53%) were diagnosed as silicosis according to the profusion category of opacities of 1/0 or greater. In this study, we reported 4-year follow-up results of this cohort. Out of 83 sandblasters who were evaluated in this follow-up study, nine died and of the remaining 74, 96% had radiographic evidence of silicosis based on the same criteria and 66% had pulmonary function loss, which was defined as at least 12% or more decrease on FVC, predicted.07 Sep Exercise Did Not Improve Mitochondrial Content in Healthy Brains
MedicalResearch.com Interview with:
Eric A.F. Herbst MSc Ph.D. student
Human Health and Nutritional Sciences
University of Guelph
Guelph, ON
Medical Research: What is the background for this study? What are the main findings?
Response: Many neurological diseases result in declines in mitochondrial content and function in the brain. Therefore, the purpose for this study was to determine if mitochondrial content could be enhanced in the brain through exercise, as previously demonstrated in skeletal muscle, and also to determine if similar exercise-signaling pathways are activated between the two tissues in the process.
This study found that despite reproducing similar findings in skeletal muscle, acute and chronic exercise did not activate traditional signaling mechanisms (AMPK, ERK1/2, CAMKII, P38) in either the cortex or striatum of the brain, nor did it result in sustained increases in mitochondrial respiration, DNA copy number, or protein content.
07 Sep Study Addresses Dairy Consumption and Frailty in Older Adults
MedicalResearch.com Interview with: Dr. Alberto Lana Department of Medicine, Preventive Medicine and Public Health Area School of Medicine and Health Sciences University of Oviedo, Oviedo, Spain Medical Research: What is the background for this study? What are the main findings? Dr. Lana: Healthy diets are associated with lower risk of frailty among elderly, but we thought that knowing the role of particular foods is essential to establish prevention measures. Dairy products are substantial sources of proteins, vitamins, and minerals, especially for older adults. Thus, dairy products could theoretically reduce the incidence of frailty. But high milk consumption could also have deleterious effects because it adds saturated fatty acids to diet and could increases oxidative stress. So the advice regarding dairy consumption remains unclear. Medical Research: What should clinicians and patients take away from your report? Dr. Lana: According to our results, clinicians should recommend replacing whole-fat products with low-fat ones. Generally, patients should be educated to perform always healthy dietetic choices.05 Sep Visual Training Can Reduce Extent of Functional Blindness
MedicalResearch.com Interview with:
Paul Miller PhD student
The University of Queensland
Australia
Medical Research: What is the background for this study? What are the main findings?
Response: All humans have a blind spot in each eye where the optic nerve, which sends signals to the brain, passes through the retina, the light sensitive layer in each eye. Where this happens you cannot detect light, so people are blind to images that project to this location.
Behaviorally, people tend to report blindness for an area that is larger than physiology dictates. We found this curious, and thought it might be driven by people reporting blindness for regions that border the blind spot, where sensitivity is degraded, but not absent. If so, we thought that this could be improved by training. When we tested this theory, we found it was true - we were able to reduce the extent of functional blindness by about 10%.
05 Sep Orthostatic Hypotension and Blood Pressure Variability Linked to Cognitive Decline
MedicalResearch.com Interview with:
Christine McGarrigle PhD
Research Director
The Irish Longitudinal Study on Ageing (TILDA)
Lincoln Gate
Trinity College Dublin Dublin
Medical Research: What is the background for this study? What are the main findings?
Dr. McGarrigle: Mild cognitive impairment (MCI) is the intermediate state between healthy ageing and dementia and is a stage at which intervention could be effective in reducing conversion to dementia.
Neurocardiovascular instability is an age-related dysregulation of the blood pressure systems manifesting as exaggerated blood pressure variability and orthostatic hypotension (OH). Previous evidence has shown that autonomic dysfunction, blood pressure variation and hypotension are associated with mild cognitive impairment.
Our study found that systolic blood pressure variation was associated with cognitive decline. Mild cognitive impairment participants were more likely to have had OH and more prolonged OH compared to cognitively normal controls. Mild cognitive impairment participants with impaired orthostatic blood pressure responses were twice more likely to convert to dementia than mild cognitive impairment participants without the impaired response over a three year follow-up period.
04 Sep Universal BRCA Screening Not Cost-Effective Until Low-Cost Reliable Genetic Testing Available
MedicalResearch.com Interview with:
Dr. Elisa Long PhD
Assistant professor
UCLA Anderson School of Management
Medical Research: What is the background for this study? What are the main findings?
Dr. Long: The study was motivated by my own diagnosis of triple-negative breast cancer last year, at the age of 33. I also learned that I carried a BRCA1 mutation, despite no family history. As a patient, I would have benefitted tremendously from a universal BRCA screening program, but as a health services researcher, I had to ask if indiscriminate screening of all women in the U.S.—where only 1 in 400 carry a mutation—is a good use of resources.
Using a previously published decision analytic model, we calculated the cost-effectiveness of universal BRCA screening. We find that compared to screening based on family history, it is not cost-effective, assuming a test price of $2,000 to $4,000. However, as the price of genetic testing continues to fall, as indicated by the $249 test now offered by Color Genomics, universal BRCA screening becomes much more affordable. Additionally, population screening of Ashkenazi Jewish women—among whom 1 in 50 carry a BRCA mutation—is very cost-effective, because the chances of finding a carrier are much higher.
04 Sep Universal TXA During Hip/Knee Replacement Reduced Transfusions 40%
MedicalResearch.com Interview with:
Dr. Gregory M.T. Hare MD PhD
Department of Anesthesia
St. Michael's Hospital
Medical Research: What is the background for this study? What are the main findings?
Dr. Hare: While many randomized trials had demonstrated that tranexamic acid (TXA therapy) was effective at reducing surgical blood loss and red blood cell transfusion in patients undergoing hip and knee replacement surgery, our hospital and many other centers in Ontario were not fully utilizing this therapy. Part of the reason was a concern about drug safety and potential side effects. While no serious adverse events had been reported using TXA, we set out to assess the impact of a protocol designed to ensure that we administered TXA (20 mg/kg iv preoperatively) to all eligible patients undergoing hip and knee replacement and determining the effect on our red blood cell transfusion rate and adverse effects including blood clot, stroke, heart attack, kidney injury and death. We excluded patients at high risk of any thrombotic complication.
After implementing our protocol, we increased utilization of the drug from 46% to 95% of eligible patients. With this increase in TXA use, we observed a 40% reduction in red blood cell transfusion. The impact was greater in patients with pre-operative anemia, but was also effective in non-anemic patients. The threshold for transfusion was not different after initiating our protocol and patients were discharged with higher red blood cell counts. Length of hospital stay remained constant and the incidence of adverse events did not increase.
04 Sep Gene Mutation May Be Key to Melanoma Chemotherapy Sensitivity
MedicalResearch.com Interview with:
Rutao Cui M. D., Ph. D.
Vice Chair, Professor
Department of Pharmacology and Experimental Therapeutic
Associate Professor of Pharmacology and Dermatology, and Member The Cancer Center
Director The Laboratory of Skin Cancer Therapeutics (LSCT)
Boston University
Medical Research: What is the background for this study? What are the main findings?
Dr. Cui: Recent studies have revealed that the APC/CCdh1 E3 ubiquitin ligase may function as a tumor suppressor. However, the tumor suppressor role of APC/CCdh1 in melanoma remains largely unclear. Here, we report sporadic mutations occurring in APC components, including Cdh1 in human melanoma samples and that loss of APC/CCdh1 may predispose human melanomagenesis.
04 Sep Sharing Laughter May Be Key To A Long-Lasting Relationship
MedicalResearch.com Interview with:
Jeffrey A. Hall PhD
Associate professor of communication studies
University of Kansas
Medical Research: What is the background for this study? What are the main findings?
Dr. Hall: Men might want to ditch the pickup lines and polish their punchlines in their quest to attract women, new research at the University of Kansas suggests.
Jeffrey Hall, an associate professor of communication studies, found that when two strangers meet, the more times a man tries to be funny and the more a woman laughs at those attempts, the more likely it is for the woman to be interested in dating. However an even better indicator of romantic connection is if the two are spotted laughing together.
Those findings were among the discoveries Hall made in his search for a link between humor and intelligence. For the past decade, research has debated whether women appreciate men’s humor, which is often cited as one of the most valued traits in a partner, because it allows them to suss out the smarts of potential mates. But Hall said finding someone who appreciates your sense of humor is valuable in its own right.
“The idea that humor is a signal of intelligence doesn’t give humor its due credit,” Hall said. “If you meet someone who you can laugh with, it might mean your future relationship is going to be fun and filled with good cheer.”
In the first study, 35 participants studied the Facebook profile pages of a 100 strangers to gauge their personalities. Their evaluations were compared to a survey completed by the Facebook users. Hall found humorous people were much more likely to be extroverted than intelligent, and were seen by strangers that way too. The data also suggested that men and women posted similar amounts of humorous content to their pages.
In the second study, nearly 300 students filled out a survey on humor in courtship. Looking at GPA and ACT scores, the study found that there was no connection between how smart the person was and how funny he or she claimed to be. But it did find a relationship with humor and extroversion. The study also didn’t find a difference in how men and women comprehended or appreciated humor.
To find out how humor used by men and appreciated by women played a role in romantic attraction, the final study brought together 51 pairs of single, heterosexual college students who didn’t know each other. The pairs sat alone in a room and talked for about 10 minutes. Afterward they filled out a survey.
The results didn’t indicate that one sex tried to be funnier than the other. However, it did suggest the more times a man tried to be funny and the more times a woman laughed at his jokes, the more likely she was romantically interested. The reverse was not true for women who attempted humor.
It also showed that when the pair laughed together, they were more interested in each other.
04 Sep Childhood Vaccination Coverage Varies By State and Poverty Status
MedicalResearch.com Interview with: Holly A. Hill, MD, PhD Immunization Services Division National Center for Immunization and Respiratory Diseases CDC Medical Research: What is the background for this study? What are the main findings? Response: The National Immunization Survey involves random digit-dialing – both landlines and cell phones – to generate a large national sample we use to assess vaccination coverage. The phone survey is followed by a mail survey sent to the children’s vaccination providers to obtain vaccination histories. This 2014 NIS report is based on 14,893 children 19-35 months of age with provider- reported vaccination records. According to the 2014 NIS, the majority of parents are vaccinating their children against potentially serious diseases. Nationally, there were no significant decreases in vaccination coverage among children 19-35 months for routinely recommended childhood vaccines in 2014. As in past years, lower coverage for vaccines recommended during the second year of life were observed. We still have opportunities for improvement. While national coverage was high for most vaccines routinely recommended for young children, vaccination coverage does vary by state and poverty status. High coverage rates for childhood vaccines explain why most vaccine-preventable diseases are at record low levels. However, it is crucial to maintain these rates in order to keep outbreaks from happening.04 Sep Do High Phthalates Levels Increase Risk of Miscarriage?
MedicalResearch.com Interview with: Dr. Jianying Hu Laboratory for Earth Surface Processes College of Urban and Environmental Sciences Peking University, Beijing People’s Republic of China Medical Research: What is the background for this study? What are the main findings? Response: Early pregnancy loss or first-trimester miscarriage is the most common complication of human reproduction, and the miscarriage incidence is increasing around the world in the recent decades. Though there are many causes for miscarriage, approximately 40% of early pregnancy loss remains unexplained. Exposure to endocrine disrupting chemicals (EDCs) has been considering one of major risk factor to affect female reproduction. Of these EDCs related to reproductive toxicity, phthalates is of concern due to their wide usage and contamination in environment, and the reproductive toxicity in the female mouse. Our study found that the levels of phthalates in the women who underwent miscarriage were statistically significantly high, and the risk of clinical pregnancy loss was associated with urinary concentration of phthalate metabolites.03 Sep Wild Blueberry Polyphenols May Help Fight Periodontal Disease
MedicalResearch.com Interview with:
Daniel Grenier, Ph.D.
Professeur titulaire
Oral Ecology Research Group, Faculty of Dentistry, and Institute of Nutrition and Functional Foods, Université Laval
Quebec City, QC, Canada
Medical Research: What is the background for this study?
Dr. Grenier: Periodontal diseases (gingivitis and periodontitis) are major public health problems because of their high prevalence and incidence in all regions of the world. According to epidemiological studies, approximately 5% of North Americans suffer from severe generalized periodontitis, which can lead to tooth loss, while mild to moderate periodontitis affects up to 35% of adults. Given emerging data indicating that there is a relationship between periodontal diseases and systemic health problems such as diabetes, cardiovascular diseases, and preterm birth, studies on preventive and therapeutic strategies targeting periodontal diseases are highly relevant.
Medical Research: What are the main findings?
Dr. Grenier: Using various in vitro models, we brought clear evidence that a blueberry extract enriched in proanthocyanidins can act on the two etiological components of periodontal disease. We first showed that these polyphenols inhibit the growth of Fusobacterium nucleatum as well as its ability to form a biofilm, which can provide to the bacterium a resistance to antimicrobial agents and immune cells. Interestingly, F. nucleatum has been associated with various forms of periodontitis as well as to a number of extra-oral infections, including endocarditis, inflammatory bowel disease, and brain abscesses. Moreover, the blueberry extract attenuated the inflammatory response of human macrophages challenged with F. nucleatum, resulting in a decreased secretion of inflammatory cytokines (IL-1β, IL-6, TNF-α) and tissue destructive enzymes (MMP-8, MMP-9). Evidence was brought that this property is likely related to the ability of the blueberry polyphenols to block the activation of the NF-κB signaling pathway that play a key role in inflammatory reactions.
Over the last decade, my laboratory has been investigating the potential benefits of various classes of polyphenols for oral health. Polyphenols are a large group of natural substances found in plants and characterized by the presence of more than one phenol unit per molecule. Given that wild blueberries (Vaccinium angustifolium Ait), a popular berry fruit in Quebec, are particularly rich in a specific class of polyphenols, called proanthocyanidins, we tested their effect on the two major etiological factors involved in the pathogenesis of periodontitis: a limited group of Gram negative anaerobic bacteria, and an uncontrolled host immune response to these pathogens that results in the secretion of high amounts of inflammatory mediators which modulate the progression and severity of periodontitis.
03 Sep Microscopic Regression in Thin Melanoma May Be Good Prognostic Sign
MedicalResearch.com Interview with:
Simone Ribero, M.D., Ph.D.
University of Turin
Department of Medical Sciences
Turin Italy and
King’s College London
Department of Twin Research and Genetic Epidemiology
St Thomas’ campus London, UK
Medical Research: What is the background for this study? What are the main findings?
Response: The histologic regression is a discussed feature and its prognostic role is debated in literature. Our group has previously described a favorable prognostic role of histological regression in stage I-II melanoma patients. Some clinicians still perform Sentinel Lymph Node biopsy on the basis of regression in thin melanoma considering this feature as able to underestimate Breslow Thickness.
In this study we described in a metanalyses with more then 10000 melanoma patients that histological regression is inversely associated with Sentinel Lymph Node positivity.
03 Sep Neurons In Brain Most Affected by Alcohol Identified
MedicalResearch.com Interview with:
Dr. Jun Wang MD PhD, Assistant Professor
Department of Neuroscience and Experimental Therapeutics
Interdisciplinary Program in Neuroscience
Texas A&M College of Medicine
Medical Research: What is the background for this study?
Dr. Wang: Alcohol use disorder is a very common disease, but the mechanism is not clear and the treatment is limited.
Medical Research: What are the main findings?
Dr. Wang: We have three findings in an animal model of alcoholism:
- Alcohol drinking changes brain cells (also called neurons), making them more excitable.
- The change occurs only in a group of neuron called D1-neurons.
- Suppressing D1-neurons in a sub-region of the brain reduces excessive alcohol intake.
03 Sep Protein Keratin Promotes Cancer Growth and Chemotherapy Resistance
MedicalResearch.com Interview with:
Kenneth R. Shroyer, MD, PhD
The Marvin Kuschner Professor and Chair
Department of Pathology
Stony Brook Medicine
Stony Brook, NY
Medical Research: What is the background for this study? What are the main findings?
Dr. Shroyer: Patients that appear to have the same type of cancer often respond very differently to treatment; while some patients appear to go into long-term regression or are cured, others follow a rapid downhill course and ultimately die of their disease. This suggests that there are fundamental differences between tumors at the biologic level that are not detected by current clinical measures.
In this study, we report the unexpected finding that cancer patients that have high levels of a protein called Keratin 17 (K17) have decreased long-term survival when compared to patients that express little to no K17 in their tumors. In addition, we found that K17 enters the nucleus of tumor cells to mediate the degradation of the master regulator of cell division and tumor growth key tumor suppressor protein, p27. Furthermore, we identified that K17 increases the resistance of tumor cells to chemotherapy.
These are critical findings because this is the first report that a keratin is an oncoprotein that can enter the nucleus to promote the development of cancer and resistance to chemotherapy.
03 Sep Melatonin Did Not Improve Fatigue in Cancer Patients
MedicalResearch.com Interview with: Charlotte Lund Rasmussen Research Unit, Department of Palliative Medicine Bispebjerg Hospital, Copenhagen, Denmark Medical Research: What is the background for this study? What are the main findings? Response: We see that patients with advanced cancer often suffer from fatigue, pain, depression, insomnia and other symptoms, which can have a profound impact on quality of life. Melatonin is a neurohormone and its secretion is closely tied to the circadian rhythm making it a regulator of the sleep-cycle. Studies have shown that cancer patients have lower levels of melatonin than healthy controls, which may contribute to their fatigue and lowered quality of life. Furthermore, previous studies have found a possible effect of melatonin in cancer therapy, and non-clinical trials have shown melatonin to inhibit cell division in tumors. To our knowledge, no trials to date have investigated the effects of melatonin on fatigue. Given the role of melatonin in the sleep cycle, the lowered levels of melatonin noted among cancer patients, and results from previous studies, we wanted to investigate melatonin’s effect on fatigue among patients with advanced cancer. The primary objective of our study was to determine whether oral melatonin administered at night would reduce physical fatigue in patients with advanced cancer who were being treated in a palliative care facility. The effect of melatonin on other cancer-related symptoms including mental fatigue, insomnia, pain, emotional function, loss of appetite, and overall QoL were also investigated. In this trial we tested a dose of 20 mg of melatonin taken orally at night. However, melatonin did not improve physical fatigue in patients with advanced cancer. Furthermore, we were unable to identify improvements in any other cancer-related symptoms.03 Sep Telemedicine May Help Patients Adopt Healthy Lifestyle and Manage Chronic Diseases
MedicalResearch.com Interview with:
Dr. Rashid Bashshur PhD
Director of Telemedicine
University of Michigan Health System
Emeritus Professor of Health Management and Policy
University of Michigan, School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Bashshur: The impetus for this research derives from the confluence of several factors, including the increasing incidence and prevalence of chronic diseases, their associated morbidity and mortality and their high cost. The search for solutions has taken center stage in health policy. Patients must be engaged in in managing their health and health care, and they must assume greater responsibility for adopting and maintaining a healthy life style to reduce their dependence on the health system and to help themselves in maintaining an optimal level of health. The telemedicine intervention promises to address all these issues and concerns, while also providing ongoing monitoring and guidance for patients who suffer from serious chronic illness.
The preponderance of the evidence from robust scientific studies points to the beneficial effects of the telemedicine intervention (through telemonitoring and patient engagement) in terms of reduction in use of service (including hospital admissions/readmissions, length of hospital stay, and emergency department visits) as well as improved health outcomes. The single exception was reported in a study among frail elderly patients with co-morbidities who did not benefit from the telemedicine intervention.
There is an ever-growing and complex body of empirical evidence that attests to the potential of telemedicine for addressing the triad problems of limited access to care, uneven distribution of quality across communities, and cost inflation. Research demonstrates the effectiveness of the telemedicine intervention in addressing all three problems, especially when patients are engaged in managing their personal health and healthcare. The enabling technology can be used to promote healthy life styles, informed decision making, and prudent use of health resources.
Unintended consequences of delaying mortality for older adults may also increase the use of resources, especially in the long run, and society must decide on the ultimate values it chooses to promote.
03 Sep Healthy Diet Not Cure-All For Depression
MedicalResearch.com Interview with:
Dr. Mila Kingsbury PhD
Senior Research Associate at Department of Epidemiology and Community Medicine
University of Ottawa
Medical Research: What is the background for this study?
Dr. Kingsbury: Eating a healthy diet, including enough fruits and vegetables, is good for physical health, and some evidence suggests that it may be good for mental health, too. Specifically, intake of fruits and vegetables has been associated with lower risk of depression.
However, there are very few longitudinal studies on this topic. Most studies haven’t accounted for the effects of other related lifestyle factors such as smoking and exercise, nor for the fact that the links between lifestyle and mental health are bidirectional (i.e., depression can also hinder our ability to engage in healthy behaviours).
Medical Research: What are the main findings?
Dr. Kingsbury: While we found an association between fruit and vegetable consumption and psychological distress and depression two years later, depression and distress also predicted future fruit and vegetable consumption. Importantly, these associations became non-significant when we controlled for lifestyle factors like smoking and exercise.
02 Sep “Happy Meal” Law Would Decrease Fat, Sugar, Salt and Calories in Kids’ Meals
MedicalResearch.com Interview with:
Brian D. Elbel, PhD, MPH
Associate professor, Departments of Population Health, Division of Health and Behavior and Medicine, Division of General Internal Medicine
Marie Bragg, PhD
Assistant professorDepartment of Population Health
Jonathan Cantor, MS
Department of Population Health, Section on Health Choice, Policy and Evaluation
NYU Langone Medical Center
MedicalResearch: What is the background for this study?
Response: On July 17th, 2014 the New York City Council proposed the “Healthy Happy Meals” bill in an effort to improve the nutritional value of fast food restaurant meals marketed to children. The bill states a restaurant cannot offer an incentive item (i.e. a toy) in combination with the purchase of a meal unless the meal met several nutritional standards.
The meals with toys would be required to:
- Be less than 500 hundred calories total
- Be less than 600 milligrams of sodium total
- Have less than 35% of total calories come from fat
- Have less than 10% of total calories come from saturated fat
- Have less than 10% of total calories come from added sugar
- Contain one half cup of fruit or vegetable or one serving of whole-grain products
02 Sep Poor Patients Receiving Care Through Ryan White Programs Achieve Better HIV Control
MedicalResearch.com Interview with:
Dr. John Weiser MD MPH
Medical epidemiologist
Division of HIV/AIDS Prevention
CDC
Medical Research: What is the background for this study? What are the main findings?
Dr. Weiser: Ryan White was an Indiana teenager diagnosed with AIDS in the late 1980s. As a result of fear and stigma, he was barred from school and went on to become a national advocate for HIV education and acceptance. This year marks the 25th anniversary of his death and passage of the Ryan White CARE Act creating The Ryan White HIV/AIDS Program (RWHAP) which provides funding for healthcare facilities to deliver needed medical care and support services for hundreds of thousands of poor, uninsured, and underinsured Americans. While increased access to Medicaid and private insurance under the Affordable Care Act will provide coverage for medical care, it might not provide coverage for support services so it is likely that the RWHAP will continue to play a key role in providing these crucial services.
Overall, 34.4 percent of facilities received Ryan White HIV/AIDS Program funding and 72.8 percent of patients received care at RWHAP-funded facilities. Many of the patients at Ryan White HIV/AIDS Program -funded facilities had multiple social determinants of poor health, with patients at RWHAP-funded facilities more likely to be ages 18 to 29; female; black or Hispanic; have less than a high school education; income at or below the poverty level; and lack health care coverage.
Despite the greater likelihood of poverty, unstable housing and lack of health care coverage, nearly 75 percent of patients receiving care at RWHAP-funded facilities achieved viral suppression. The percentage of ART (antiretroviral therapy) prescribing was similar for patients at RWHAP-funded compared with non-funded facilities. Patients at RWHAP-funded facilities were less likely to be virally suppressed. However, individuals at or below the poverty level and those ages 30 to 39 who received care at a RWHAP-funded facility compared with those who received care at a non-RWHAP-funded facility were more likely to achieve viral suppression.
02 Sep Distance From Hospital Linked To Worse 30-Day Cardiac Surgery Outcomes
MedicalResearch.com Interview with:
Dr. Ansar Hassan MD PhD
Department of Cardiac Surgery
New Brunswick Heart Centre
Saint John Regional Hospital
Saint John, New Brunswick
Medical Research: What is the background for this study? What are the main findings?
Dr. Hassan: For years, geographic place of residence and one’s proximity to a tertiary care center has been identified as a predictor for access to care. Little is known regarding the effect of geography on patient outcomes. The purpose of this study was to explore the relationship between geography and in-hospital / 30-day outcomes among patients undergoing cardiac surgery. What we found was that despite there being no relationship between geography and in-hospital outcomes, those who lived further away from hospital clearly had worse 30-day outcomes.
Medical Research: What should clinicians and patients take away from your report?
Dr. Hassan: While patients from a differing geographic places of residence appear to have similar in-hospital outcomes following cardiac surgery, their clinical courses following discharge from hospital differ considerably. Clinicians and patients need to realize that where one lives is tremendously important as it relates to his or her health and that particular attention needs to be paid to cardiac surgery patients who live further away from their tertiary care center, especially within the first 30 days following surgery.
02 Sep Gene Variant May Explain Why Some Children Respond More Aggressively To Stress
MedicalResearch.com Interview with:
Beate W. Hygen PhD Student
Department of Psychology
Norwegian University of Science and Technology Social Science
Medical Research: What is the background for this study?
Response: The study is part of the Trondheim Early Secure Study (TESS) conducted at the Department of Psychology, Norwegian University of Science and Technology (NTNU) and NTNU Social Science. The main aim of TESS is to detect risk and protective factors with regards to children’s mental health and well-being. TESS examines multiple factors which may play a role in children`s development.
There is substantial research, based on diathesis-stress theorizing, indicating that some individuals, including children, are more susceptible to the negative effects of contextual adversity than are others. However, according to differential susceptibility theory, such "vulnerable" individuals may also be the ones that benefit the most from positive environmental conditions. Thus, some individuals are more malleable for "better and for worse" to environmental exposures. The article Child exposure to serious life events, COMT, and aggression: Testing differential susceptibility theory was designed to examine if the COMT polymorphism moderated the effect of early-life adversity on aggressive behavior. Thus, we sought to competitively evaluate which model of person X environment interaction best accounted for the anticipated differential effects of life event stress on children's aggressive behavior.
02 Sep Cancer Driver Log Facilitates Precision Medicine, Linking Providers With Genetic Data Bank
MedicalResearch.com Interview with:
Sameek Roychowdhury, MD, PhD
Assistant Professor, Internal Medicine, College of Medicine
Assistant Professor, Department of Pharmacology
College of Pharmacy
Department of Internal Medicine
Division of Medical Oncology
Wexner Medical Center
The Ohio State University
Medical Research: What is the background for this study? What are the main findings?
Dr. Roychowdhury: Precision cancer medicine is a new paradigm to match patients to therapies based on the molecular alterations in their cancer. Novel genomic testing of cancer using next generation sequencing can reveal numerous mutations for each patient across many genes and types of cancer, and this requires detailed time-intensive interpretation. Driver mutations can confer a selective growth or survival advantage to cancer cells, while passenger mutations do not.
Cancer Driver Log, or CanDL, is meant to aid interpretation of mutations by providing the latest literature evidence for individual driver mutations, and thereby aiding pathologists, lab directors, and oncologists in interpreting mutations found in their patient’s cancer.
02 Sep Serious Injuries Rise As Older Age Groups Takes Up Cycling
MedicalResearch.com Interview with:
Benjamin N. Breyer MD, MAS, FACS
Associate Professor in Residence
Department of Urology
University of California, San Francisco
Chief of Urology, San Francisco General Hospital
Director, UCSF Male Genitourinary Reconstruction and Trauma Surgery Fellowship
Medical Research: What is the background for this study? What are the main findings?
Dr. Breyer: Our group has studied genitourinary-specific injuries associated with bicycles using a national surveillance injury database called NEISS (National Electronic Injury Surveillance System), that monitors injuries associated with specific products. In the current study, we examined trends in all bicycle-related injuries from 1997 to 2013. We found an increase in bicycle-related injuries over the study period, even after adjusting for growth in the US population. Even more concerning, we found the percentage of bicycle-related injuries resulting in admission increased 120%, suggesting the injuries sustained while cycling are becoming more severe. These trends appear to be driven by a substantial rise in both injuries and admissions in individuals over 45 years of age, which likely reflects a change in the demographic of cyclists in the US - multiple studies have shown an increase in the cycling participation of adults over the age of 45.
Bicycles are no longer children's toys - they are increasingly being used by adults as a means of transportation and physical activity. The rise in cycling in adults over the age 45 appears to be driving both the increase in injuries and admissions, suggesting that older individuals are at increased risk for sustaining severe injury while cycling.
02 Sep Genetic Signatures May Lead To Precision Treatments For Childhood Brain Tumors
Medicalresearch.com Interview with:
Roger Packer MD
Senior Vice President
Center for Neuroscience & Behavioral Health
Children's National Medical Center
Washington, D.C.
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Packer: The background is that medulloblastoma is the most common childhood malignant brain tumor. It carries with it a variable prognosis. For some subsets of patients, with current available treatment which includes surgery, radiation and chemotherapy, we see survival rates as high as 90% (and often cures) 5 years following diagnosis and treatment. However, for some subsets of patients, survival rates are much poorer, in those with higher risk characteristics as low as 40% at 5 years. Current treatment also carries with it a significant risk for long term sequelae, including intellectual loss secondary to radiation therapy and persistent, at times devastating neurologic complications such as unsteadiness.
To try to improve our understanding and ultimately our therapy for medulloblastoma, an international working group has shared patient specimens and patient information to attempt to determine what the molecular predictors of outcome are for children with medulloblastoma and if such molecular genetic findings can be used to develop better, safer therapies. Children’s National is part of this international collective of institutions, which published this and other studies.
The main findings of this study are that complex, integrated genetic analysis of tumor specimens can be used to better understand and set the scene for better treatment of medulloblastoma. Medulloblastoma can be broken into relatively distinct, molecular subtypes each with its own prognosis and potential therapy. A major finding of this study was that within a given tumor, different areas showed the same molecular genetic pattern. The importance of this is that since the tumors are relatively the same in different areas, molecularly-targeted therapies have an excellent chance of working on the entire tumor, resulting in better tumor control and safer treatments.