Author Interviews, End of Life Care, JAMA, Outcomes & Safety / 15.04.2015

Mihaela S Stefan, MD FACP Research Scientist, Center for Quality of Care Research Director of Outpatient Perioperative Clinic and Medical Consultation Program Academic Hospitalist Baystate Medical Center Assistant Professor of Medicine, Tufts University School of Medicine Springfield MA 01199MedicalResearch.com Interview with: Mihaela S Stefan, MD FACP Research Scientist, Center for Quality of Care Research Director of Outpatient Perioperative Clinic and Medical Consultation Program Academic Hospitalist Baystate Medical Center Assistant Professor of Medicine, Tufts University School of Medicine Springfield MA 01199 MedicalResearch: What is the background for this study? Dr. Stefan : Mortality rates for patients with pneumonia are publicly reported and are used to evaluate hospital performance. The rates are calculated using Medicare administrative claims data which provide limited insight into severity of illness and comorbidities that may be associated with death. The mortality measure does not take into consideration advance directives or changes in goals of care preferences during hospitalization. MedicalResearch: What are the main findings? Dr. Stefan : In this retrospective chart review of 202 adults who died with a principal diagnosis of pneumonia between January 2008 and December 2012 in 3 hospitals in MA, we assessed the proportion of patients for whom pneumonia was determined to play a major or a minor role in the patient death. Pneumonia was considered a minor cause if the patient had advanced life threatening illnesses and this was found in 82% of the deaths. More than half of the patients were DNR at admission to the hospital. The majority of patients who died were frail elderly with life-threatening conditions who decided to forgo aggressive care at some point during their admission. Only a small fraction of deaths in the pneumonia mortality measure were the direct result of pneumonia. (more…)
Author Interviews, Exercise - Fitness, Salt-Sodium / 14.04.2015

Edward "Ted" Weiss, Ph.D. Associate Professor Department of Nutrition and Dietetics Saint Louis University Saint Louis MO 63104MedicalResearch.com Interview with: Edward "Ted" Weiss, Ph.D. Associate Professor Department of Nutrition and Dietetics Saint Louis University Saint Louis MO 63104 Medical Research: What is the background for this study? What are the main findings? Dr. Weiss: Public health recommendations are to keep sodium consumption below 2300 mg/day to avoid adverse health effects. However, most people in the US consume over 4000 mg/day. Furthermore, endurance athletes are often advised to add sodium to their diets to replace the sodium that is lost in sweat and are often lead to believe that the additional sodium is important for exercise performance. Clearly these recommendations are at odds with each other. In a double-blind placebo-controlled trial, we evaluated the effect of salt capsule consumption (containing a 1800 mg sodium) on exercise performance and on thermoregulation during 2 - 2.5 hours of running or cycling. Exercise performance was not different between the salt and placebo conditions (i.e. it didn't provide benefit or harm for performance) nor did any of the markers of thermoregulation differ, suggesting that the salt didn't help (or hurt) the body's ability to cool itself. (more…)
Author Interviews, Mental Health Research, Probiotics / 14.04.2015

MedicalResearch.com Interview with: Laura Steenbergen Leiden University, Institute for Psychological Research, Cognitive Psychology Leiden, The Netherlands Medical Research: What is the background for this study? What are the main findings? Response: Food supplements, among which probiotics, are becoming more and more popular. A lot is known about the effect of probiotics on the physical functioning, but even though there are some rat studies on the effects of probiotics on mental well-being, not much is known about the effect in humans. The few studies on humans that are available show beneficial effects on mood when people experience a bad mood, or psychological distress. Worldwide, millions of people are suffering from mood disorders like for instance depression, but not everyone receives treatment for this. Research on probiotics has shown that they are safe and easily available, and we therefore wanted to investigate if probiotics could perhaps be promising in serving as a preventive or adjuvant therapy for mood disorders of anxiety or depression. We therefore focused on cognitive reactivity to sad mood, which measures the degree to which people activate dysfunctional thought patterns when experiencing a sad mood. This measure is known to be predictive of the onset and development of depression. Compared to subjects who received a 4-week placebo intervention, participants who received a 4-week multispecies probiotics intervention showed significantly reduced aggressive and ruminative thoughts. Even if preliminary, these results provide the first evidence that the intake of probiotics may help reduce negative thoughts associated with sad mood. As such, our findings shed an interesting new light on the potential of probiotics to serve as adjuvant or preventive therapy for depression. So if you are interested in taking probiotics then you could check out something like these probiotics in india. (more…)
Author Interviews, Cancer Research, Cost of Health Care, HPV, Vaccine Studies / 14.04.2015

MedicalResearch.com Interview with: Lillian Siu, MD, FRCPC Princess Margaret Cancer Centre University Health Network Toronto Medical Research: What is the background for this study? What are the main findings? Dr. Siu: Our study is a collaboration between researchers at the Princess Margaret Cancer Centre and the Canadian Center for Applied Research in Cancer Control. The study involves a statistical model being applied to a hypothetical population of 192,940 Canadian boys who were 12 years old in 2012, to determine the cost effectiveness of HPV vaccination for the prevention of oropharyngeal cancer.  On the basis of this model, HPV vaccination for boys aged 12 years appears to be a cost-effective strategy for the prevention of oropharyngeal cancer in Canada. There are limitations to our study as it is based on statistical modelling with many assumptions. For instance, we could not easily address the impact of herd immunity which refers to the indirect protective effect offered by HPV vaccination in women. Based on our statistical model, despite its limitations, the vaccine can potentially save $8 to $28 million CAD for a theoretical group of 192,940 Canadian 12-year old boys in 2012 over their lifetime. As stated, this is based on a theoretical model and not a randomized study, the results are relevant especially that HPV-related oropharyngeal cancer is increasing in incidence and HPV is surpassing smoking as a risk factor for this cancer in many developed countries. Currently, the National Advisory Committee on Immunization (NACI) of the Public Health Agency of Canada recommends HPV vaccination of females 9 through 26 years of age to prevent cervical, vulvar, vaginal and anal cancers, and for anogenital warts; and of males 9 through 26 years of age to prevent anal canal cancers and their precursors, and for anogenital warts. However, funding is also provided for HPV vaccination in young females and not in young males. (more…)
Author Interviews, Cost of Health Care, Emergency Care / 14.04.2015

Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at BirminghamMedicalResearch.com Interview with: Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at Birmingham MedicalResearch: What is the background for this study? Dr. Xin: Since high cost-sharing policies can reduce both needed care and unneeded care use, it raises the concern whether these policies are a good strategy for controlling costs among chronically ill patients, especially whether utilization and costs in emergency department (ED) service and inpatient care will increase in response. Moreover, the costs saved by reduced physician care may be offset or even exceeded by the increased ED or inpatient care expenditures, causing a total cost increase for health plans. This study was the first to examine whether high cost-sharing policies for physician care are associated with a differential impact on total care costs between chronically ill individuals and healthy individuals. Total care includes physician care, ED service and inpatient care. MedicalResearch: What are the main findings? Dr. Xin:  Chronically ill individuals’ probability of reducing any overall care costs was significantly less than healthier individuals (β= 2.18, p = 0.04), while the integrated Difference-in-difference estimator from split results in the two-part model indicated that going from low cost-sharing to high cost-sharing significantly reduced costs by $12,853.23 more for sick people than for healthy people (95% CI: -$17,582.86, -$8,123.60). (more…)
Author Interviews, Biomarkers, BMJ, Cancer Research, Gastrointestinal Disease / 14.04.2015

MedicalResearch.com Interview with: Professor Hossam Haick Ph.D Department of Chemical Engineering and Russell Berrie Nanotechnology Institute Haifa, Israel Medical Research: What is the background for this study? What are the main findings? Dr. Haick: Our study is based on the hypothesis that timely detection of premalignant lesions (PMLs) may provide a tool to decrease either cancer mortality or incidence, thought, currently, there is no perfect non-invasive tool to screen for gastric cancer (GC) and the related premalignant lesions. Using 1002 samples collected from 501 volunteers, we show for the first time that premalignant lesions (PMLs) relevant to (gastric) cancer result in detectable differences in Volatile Organic Compound (VOC) signatures that can be detected and classified non-invasively through exhaled breath. We show additionally that these premalignant lesions can be well-discriminated from various stages of gastric cancer as well as other background stomach diseases. (more…)
Aging, Author Interviews, Heart Disease / 12.04.2015

MedicalResearch.com Interview with: Salah Altarabsheh, MD,MRCSI Cardiac Surgery Senior Specialist Queen Alia Heart Institute Amman, Jordan Coronary artery bypass grafting is the most common surgical procedure performed by cardiac surgeons worldwide. With the increased life expectancy for the general population, and the added comorbidities among elderly population, we are seeing a good number of elderly populations who are referred for coronary artery bypass surgery. There are few reports which compare off-pump versus on-pump methods of revascularization among this subset of elderly people. We choose octogenarians in our meta-analysis to see whether off-pump revascularization method could be of benefit since there is increased chance to have ascending aortic calcifications among these patients, and off-pump coronary artery bypass in which there is lesser chance for aortic manipulations, can be beneficial. (more…)
Author Interviews, Weight Research / 12.04.2015

MedicalResearch.com Interview with: May May Leung Ph.D. Hunter College School of Urban Public Health, City University of New York School of Public Health New York, NY MedicalResearch: What is the background for this study? Dr. Leung: Shanghai and New York City are two urban centers that play a key role in the global economy. However, both cities are facing elevated rates and inequitable distributions of childhood obesity. Given the role that obesity plays in the etiology of chronic diseases, this epidemic calls for interurban learning to better understand some of its diet-related determinants. In turn, this paper attempts to explore how culture, history and politics have influenced the rates and distributions of childhood obesity in Shanghai and New York City, to inform public health officials as to what approaches could be taken to address the epidemic in ‘world cities’. (more…)
Author Interviews, Depression, JAMA, Race/Ethnic Diversity, University of Michigan / 11.04.2015

Addie Weaver PhD Research Investigator and LEO Adjunct Lecturer School of Social Work University of MichiganMedicalResearch.com Interview with: Addie Weaver PhD Research Investigator and LEO Adjunct Lecturer School of Social Work University of Michigan Medical Research: What is the background for this study? What are the main findings? Dr. Weaver: The mental health of both African Americans and rural Americans has been understudied. Though depression is one of the most common, debilitating mental illnesses among women, very little is known about depression among African American women living in rural areas of the United States. In fact, much of what we know about rural women's depression in general is based on research conducted with community samples, as limited epidemiolgical research includes large enough samples of both African American respondents and rural respondents to assess potentially important subgroup differences by urbanicity (e.g., urban, suburban, rural) and race. Our study used the National Survey of American Life, the first and only nationally representative survey of African Americans, to examine the interaction of urbanicity and race/ethnicity on Major Depressive Disorder and mood disorder prevalence among African American and non-Hispanic white women residing in the South. We found that rural residence has a differential effect on depression and mood disorder for African American women and non-Hispanic white women. Overall, African American women living in rural areas experienced significantly lower odds of meeting criteria for lifetime and 12-month Major Depressive Disorder and lifetime and 12-month mood disorder than urban African American women. Conversely, non-Hispanic white women residing in rural areas had significantly higher odds of meeting criteria for lifetime and 12-month Major Depressive and lifetime and 12-month mood disorder when compared to rural African American women, and had significantly higher prevalence rates of 12-month Major Depressive Disorder and 12-month mood disorder than urban non-Hispanic white women. All analyses controlled for age, education level, household income, and marital status, suggesting that the urbanicity differences were not due to resource disparities often experienced by individuals residing in rural communities. (more…)
Author Interviews, Cost of Health Care, Hepatitis - Liver Disease / 10.04.2015

Brian Montague, DO MS MPH Assistant Professor of Medicine and of Health Services, Policy and Practice Division of Infectious Diseases Brown University / The Miriam HospitalMedicalResearch.com Interview with: Brian Montague, DO MS MPH Assistant Professor of Medicine and of Health Services, Policy and Practice Division of Infectious Diseases Brown University / The Miriam Hospital Medical Research: What is the background for this study? Dr. Montague: Hepatitis C is in an important public health problem affecting 4-5 million persons in the US alone.  Given the risk of infection associated with drug use, the prevalence of hepatitis C in corrections has been significantly higher than in the general population. Prior to 2013, the available treatment options were both expensive and of significant toxicity and limited efficacy.  Uptake to these therapies were low.  Starting in 2013, new therapeutics options offering shorter course treatments and efficacies greater than 90% became available.  These therapies offer new possibilities to increase uptake to treatment, however the cost of the therapies has made rapid scale up of treatment impossible.  Given the risk of serious harms to patients with advanced liver disease if not treated, insurance has begun to approve these new therapies for patients with more advanced disease. Departments of corrections are obliged to provide the same standard of care to persons in corrections as they would receive in the community.  Unlike Medicaid and community insurance providers, correctional systems worker under a fixed budget. Large increases in expenditures for treatment of hepatitis C without establishing mechanisms to offset these costs risks compromising other essential programs and functions in the correctional health system. Medical Research: What are the main findings? Dr. Montague: In a cross-sectional analysis we estimated the burden of hepatitis C within the department of corrections.  At the time of the study, an estimated 836 persons have chronic hepatitis C.  Among these an estimated 119 have advanced liver disease, stage 3 or 4 fibrosis, and would meet criteria for treatment under most insurance programs.  Even a conservative approach of restricting treatment in corrections to those with stage 3 or 4 fibrosis would incur costs of over $15 million, which is greater than 6 times the current correctional health budget for pharmaceuticals and 76% of the overall correctional health budget. (more…)
Author Interviews, Cancer Research, Cost of Health Care, JAMA / 10.04.2015

Gabriel Brooks, MD Gastrointestinal Cancer Center Dana-Farber Cancer Institute MedicalResearch.com Interview with: Gabriel Brooks, MD Gastrointestinal Cancer Center Dana-Farber Cancer Institute Medical Research: What is the background for this study? What are the main findings? Dr. Brooks: The background for our study is that hospitalizations in patients with cancer are common, costly, and distressing to patients.  Acute hospital care is the single largest expenditure category in cancer care, accounting for substantially greater costs than even chemotherapy. However, patients generally wish to avoid hospitalization, and they certainly want to avoid complications of treatment that can lead to hospitalization. For these reasons, we sought to identify the extent to which hospitalizations are perceived as potentially avoidable by clinicians who are directly involved in patient care. We interviewed three physicians for each of 103 patients with cancer who experienced a hospitalization. For 24 patients (23%) two or more of the three physicians agreed that hospitalization had been potentially avoidable. (more…)
Author Interviews, Genetic Research, Nature, Pancreatic, UT Southwestern / 10.04.2015

Dr. Agnieszka Witkiewicz MD Associate Professor of Pathology Harold C. Simmons Comprehensive Cancer Center UT SouthwesternMedicalResearch.com Interview with: Dr. Agnieszka Witkiewicz MD Associate Professor of Pathology Harold C. Simmons Comprehensive Cancer Center UT Southwestern MedicalResearch: What is the background for this study? Dr. Witkiewicz: Pancreatic ductal adenocarcinoma (PDA) has a dismal prognosis, with a five year survival rate of approximately 6%. This poor outcome is related to multiple factors, including the relatively late stage of diagnosis, many patients presenting with unresectable disease, and therapy recalcitrance resulting in disease recurrence in spite of operable disease and systemic therapy. Thus far, insights into how to target the treatment of Pancreatic ductal adenocarcinoma have remained unclear in spite of prior sequencing efforts. MedicalResearch: What are the main findings? Dr. Witkiewicz: The underlying critical finding of the study was that Pancreatic ductal adenocarcinoma is genetically diverse and that, in principle, this diversity could be exploited for the treatment of disease.   Specifically, many cases harbored deregulation in pathways that are the target for drug development.   For example, we identified cases that were driven by BRAF V600E and that were sensitive to the FDA approved drug Vemurafenib.   Similarly, multiple cases harbored defects in DNA repair processes that impart sensitivity to select chemotherapeutic agents and PARP inhibitors.  Common pathway deregulation was observed in reference to beta-catenin, notch, hedgehog, chromatin remodeling, and cell cycle regulatory pathways that are all targets for therapeutic intervention. (more…)
Author Interviews, Microbiome, Pediatrics, Weight Research / 10.04.2015

MedicalResearch.com Interview with: Lisa J. Martin PhD Professor Division of Human Genetics Jessica G. Woo PhD Associate Professor Division of Biostatistics and Epidemiology Cincinnati Children’s Hospital Medical Center Cincinnati, OH MedicalResearch: What is the background for this study? Response: Obesity is a major public health concern. In the past 30 years, more and more children are being considered obese. Because treatment is challenging, researchers are looking toward prevention. The health benefits of breastfeeding over infant formula feeding are well recognized, including evidence that breastfeeding may protect against obesity. But, how much protection it provides and the reasons for protection are unclear. Thus, the purpose of this paper was to examine the relationship between breastfeeding and reduced risk of obesity later in life, with special emphasis on potential mechanisms. MedicalResearch: What are the main findings? Response: After reviewing more than 80 studies conducted over a period of 20 years, the authors showed that breastfeeding is associated with a 10 to 20 percent reduction in obesity prevalence in childhood. Mechanisms that connect human milk and infant physiology include maternal obesity, development of a healthy gut environment (microbiome) in the infant, and the development of taste preference and diet quality. Importantly, each of these mechanisms can be influenced by biologic and social factors which may directly and indirectly affect the child’s obesity risk. (more…)
Author Interviews, Genetic Research, JAMA, Melanoma / 10.04.2015

Nancy E. Thomas, MD, PhD Department of Dermatology University of North CarolinaMedicalResearch.com Interview with: Nancy E. Thomas, MD, PhD Department of Dermatology University of North Carolina MedicalResearch: What is the background for this study? Dr. Thomas: BRAF and NRAS mutations found in melanomas are important for tumor initiation and maintenance. There are drugs that target BRAF mutations or the pathway that are approved for BRAF-mutant metastatic melanoma and help improve survival. However, it remains unknown whether these mutations in primary melanoma are markers for melanomas with a worse prognosis. MedicalResearch: What are the main findings? Dr. Thomas:
  • In a large international population-based study, we found that of primary melanomas, 30% harbor BRAF mutations, 13% have NRAS mutations and the other 57% do not have these mutations (wildtype).
  • In higher primary tumor stage melanomas, BRAF or NRAS mutations were associated with an approximately 3-fold increased rate of death from melanoma compared to wildtype melanoma adjusted for other prognostic factors.
  • Primary melanomas with NRAS mutations were less likely to have tumor infiltrating lymphocytes (TILs) in the tumor microenvironment. (more…)
Author Interviews, Diabetes, Diabetologia, Pediatrics, Social Issues / 10.04.2015

MedicalResearch.com Interview with: Maria Nygren Division of Pediatrics Linköping University, Sweden MedicalResearch: What is the background for this study? What are the main findings? Response: What factors that cause type 1 diabetes is still unknown, but we know that environmental factors are involved besides the genetics. Since the incidence of type 1 diabetes among children have increased worldwide in recent decades, it is important to find out the reasons behind the disease to hopefully be able to prevent new cases. We have in a prospective study of over 10000 children and their parents in Sweden investigated if psychological stress can be a risk-factor, and found that childhood experience of serious life events (such as death/illness in family, divorce, new adult/child in the family) was associated with increased risk for diagnosis of type 1 diabetes up to 14 years of age. (more…)
Author Interviews, Infections / 10.04.2015

Catherine M. Stein, PhDAssociate professor of epidemiology and biostatistics Case Western Reserve Dr. Stein is a leader of international research on resistance to Mycobacterium tuberculosis (MTB) infectionMedicalResearch.com Interview with: Catherine M. Stein, PhD Associate professor of epidemiology and biostatistics Case Western Reserve Dr. Stein is a leader of international research on resistance to Mycobacterium tuberculosis (MTB) infection MedicalResearch: What is the background for this study? What do you hope to learn? Dr. Stein: In a 2002 study, we began to clinically characterize people who lived in households where there were infectious tuberculosis cases. We followed them for a two-year period and noticed that approximately 9 percent of household members were resistant to Mycobacterium tuberculosis (MTB) infection, even though they were highly exposed to the organism. This finding surprised us because the prevailing notion had been that everyone living in TB-endemic settings or living with someone who has TB would become infected eventually. After several years of study, we found a substantial number of these people who do not have any evidence for MTB infection, so we wanted to do studies to learn if we could figure out why. MedicalResearch: Is MTB resistance a new phenomenon? Do MTB resisters react to a tuberculin purified protein derivative (PPD) or a gold immunoassay but don’t develop clinical disease? Dr. Stein: We don’t have any reason to believe that MTB-infection resistance is a new phenomenon. It’s just that no one has thought to look for it before. In terms of the PPD or gold immunoassays, MTB-resisters produce a negative response to both tests. The way gold immunoassays are done, three tubes are collected. One is a control. Another is a test for reacting to MTB. Still another is a positive control to make sure immune cells are alive. The MTB-resisters show a response to that positive control but not to MTB. It’s not that these patients don’t have an immune response. It’s just that they have no response to MTB, which means they have no previous exposure to cause their T-cells to make that response. MedicalResearch: Are MTB-resisters immune to the newer multi-drug resistant strains of TB? Dr. Stein: Resistance to MTB infection is independent of the drug resistance pattern of the bacteria. Thus we would expect them to resist multidrug resistant (MDR)-TB as well. There is no strong evidence that MDR-TB is more aggressive or virulent. (more…)
Author Interviews, Depression, Endocrinology, Testosterone / 09.04.2015

Mohamed Kabbaj, PHD Professor of Biomedical Sciences & Neurosciences College of Medicine Florida State UniversityMedicalResearch.com Interview with: Mohamed Kabbaj, PHD Professor of Biomedical Sciences & Neurosciences College of Medicine Florida State University Medical Research: What is the background for this study? What are the main findings? Dr. Kabbaj: While anxiety and depressive disorders a major public health concern worldwide, so too are the pervasive sex differences that exist within these pathologies. Fluctuations in the predominant female reproductive hormones, estradiol and progesterone, are thought to be a major contributor to the higher prevalence of anxiety and depression in women compared to men. However, many studies in humans and rodents alike have demonstrated that testosterone, the primary male sex hormone, also influences affective status and may yield protective benefits against the development of mood-related disturbances. Indeed, hypogonadal males with low testosterone levels experience increased rates of anxiety and depressive symptoms. In many of these cases, testosterone replacement alone or in addition to antidepressant medication have been shown to effectively improve mood. How this hormone acts in the brain to exert its beneficial effects, however, is much less clear. Interestingly, it is well-known that many of testosterone’s effects in the brain occur via its conversion to estrogen by the enzyme aromatase. What remained unclear was whether or not this conversion to estrogen was critical for testosterone’s protective anxiolytic and antidepressant effects—so Nicole Carrier and Samantha Saland from Dr. Kabbaj’s lab aimed to figure out just that. To do this, Carrier and Saland targeted an area of the hippocampus in the brain involved in mood regulation where testosterone is known to act to carry out some of its anxiolytic and antidepressant effects in male rats. Here, they inhibited the enzyme responsible for the conversion of testosterone into estrogen and investigated performance in mood-related behaviors. In doing so, they discovered that testosterone’s anxiolytic- and antidepressant-like effects were lost unless this hormone was first converted into estrogen. Importantly, they also found that continuous testosterone and estrogen treatments had very similar effects on the expression of genes within this brain region that are highly implicated in the regulation of mood as well as antidepressant treatments. (more…)
Author Interviews, Cost of Health Care, Emergency Care, Primary Care / 09.04.2015

Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at BirminghamMedicalResearch.com Interview with: Haichang Xin, PhD Department of Health Care Organization and policy School of Public Health University of Alabama at Birmingham MedicalResearch: What is the background for this study? Dr. Xin: Research suggests that nearly half of all emergency department (ED) visits in the United States are for nonurgent conditions, leading to billions of dollars in potentially avoidable spending annually. A well-functioning primary care system has the capacity to provide timely, adequate, and effective care for patients in order to avoid nonurgent emergency department use and care costs. This study examined how deficiencies in ambulatory care were associated with nonurgent emergency department care costs nationwide, and to what extent these costs can be reduced if deficiencies in primary care systems could be improved. MedicalResearch: What are the main findings? Dr. Xin: Patient perceived poor and intermediate levels of primary care quality had higher odds of nonurgent emergency department care costs (OR=2.22, p=0.035, and OR=2.05, p=0.011, respectively) compared to high quality care, with a marginal effect (at means) of 13.0% and 11.5% higher predicted probability of nonurgent ED care costs. These ambulatory care quality deficiency related costs amounted up to $229 million for private plans (95% CI: $100 million, $358 million), $58.5 million for public plans (95% CI: $33.9 million, $83.1 million), and an overall of $379 million (95% CI: $229 million, $529 million) at the national level. (more…)
Author Interviews, Circadian Rhythm, Ophthalmology, Sleep Disorders, UCSD / 09.04.2015

MedicalResearch.com Interview with: Carolina P B Gracitelli, M.D. Ophthalmology - PhD Candidate/ Research Fellow University of California San Diego - Hamilton Glaucoma Center Medical Research: What is the background for this study? What are the main findings? Dr. Gracitelli: Of all the diseases that can lead to blindness, glaucoma is one of the most important diseases; it affects more than 70 million people worldwide, of whom approximately 10 % are bilaterally blind. Different studies have reported that the damage caused by glaucomatous disease lead to retinal ganglion cell (RGC) loss and consequently loss of intrinsically photosensitive retinal ganglion cells (ipRGCs), which is a subtype of RGC. This subpopulation of RGC is clearly related with non-image-forming visual function such as photic synchronization of circadian rhythms and the pupillary light reflex. However, the true impact of glaucoma on sleep quality, sleep disturbance or circadian rhythm was until nowadays controversial. The main clinical finding of our study was that glaucoma leads to RGC death, including ipRGC death. These cells are connected to several non-image-forming functions, including circadian photoentrainment and pupillary reflexes. Therefore, the image-forming and non-image-forming visual systems are associated with glaucoma. Circadian function has not been well investigated in clinical daily practice, but it can interfere with the quality of life of these patients. Concerns about sleep disturbances in glaucoma patients should be incorporated into clinical evaluations. Medical Research: What should clinicians and patients take away from your report? Dr. Gracitelli: Our data support the concept that glaucoma is associated with a loss of ipRGCs that mediate the pupillary light response, particularly to the sustained component of the blue flash with a luminance of 250 cd/m2. Additionally, glaucoma patients had significant sleep disturbances that were inversely correlated with a measure of ipRGC function, the pupillary light reflex. These results suggest that the loss of ipRGCs in glaucoma may also lead to sleep disturbances. Both non-visual functions of ipRGCs are correlated, indicating that attention should be paid to the non-image forming visual functions in glaucoma patients. Medical Research: What recommendations do you have for future research as a result of this study? Dr. Gracitelli: Sleep disorders is a complex system, therefore, some conclusions in this study should be carefully evaluated. Further studies with larger cohorts could also help to elucidate the association between the pupillary reflex and the polysomnography parameters. And longitudinal studies can better explain the associations between sleep disorders and glaucoma progression. In addition, we know that there are several types of ipRGCs and they have specific functions (pupillary reflex or circadian rhythms), therefore, evaluations would also need to include a more thorough assessment to understand better the specific role of ipRGCs in sleep disturbances. However, it is true that these ipRGCs functions are impaired in glaucoma, affecting the quality of life of these patients. Citation: Intrinsically Photosensitive Retinal Ganglion Cell Activity Is Associated with Decreased Sleep Quality in Patients with Glaucoma Gracitelli, Carolina P.B. et al. Ophthalmology Published Online: April 06, 2015 DOI: http://dx.doi.org/10.1016/j.ophtha.2015.02.030MedicalResearch.com Interview with: Carolina P B Gracitelli, M.D. Ophthalmology - PhD Candidate/ Research Fellow University of California San Diego - Hamilton Glaucoma Center Medical Research: What is the background for this study? What are the main findings? Dr. Gracitelli: Of all the diseases that can lead to blindness, glaucoma is one of the most important diseases; it affects more than 70 million people worldwide, of whom approximately 10 % are bilaterally blind. Different studies have reported that the damage caused by glaucomatous disease lead to retinal ganglion cell (RGC) loss and consequently loss of intrinsically photosensitive retinal ganglion cells (ipRGCs), which is a subtype of retinal ganglion cell. This subpopulation of RGC is clearly related with non-image-forming visual function such as photic synchronization of circadian rhythms and the pupillary light reflex. However, the true impact of glaucoma on sleep quality, sleep disturbance or circadian rhythm was until nowadays controversial. The main clinical finding of our study was that glaucoma leads to retinal ganglion cell death, including ipRGC death. These cells are connected to several non-image-forming functions, including circadian photoentrainment and pupillary reflexes. Therefore, the image-forming and non-image-forming visual systems are associated with glaucoma. Circadian function has not been well investigated in clinical daily practice, but it can interfere with the quality of life of these patients. Concerns about sleep disturbances in glaucoma patients should be incorporated into clinical evaluations. (more…)
Author Interviews, Blood Pressure - Hypertension, Compliance / 08.04.2015

MedicalResearch.com Interview with: Amneet Sandhu, MD Department of Internal Medicine Division of Cardiovascular Medicine University of Colorado Aurora, CO 80045. Medical Research: What is the background for this study? What are the main findings? Dr. Sandhu: Control of hypertension has improved nationally to guideline recommended levels.  To date, the focus of hypertensive care has been around identification and appropriate treatment to blood pressure goals.  Less emphasis has been placed on maintenance of control or tracking patients with high rates of relapse after achieving control. This study sought to assess the rate of recidivism in a cohort of hypertensive patients with controlled blood pressure and identify patient and process of care factors associated with recidivism.  We found approximately 25% of hypertensive patients with baseline controlled blood pressure relapse over a median time period of 7.3 months.  Patients with diabetes, high normal baseline blood pressure and poor medication adherence were more likely to suffer from recidivism. (more…)
Author Interviews, Blood Pressure - Hypertension, Social Issues, University of Michigan / 08.04.2015

Kira S. Birditt, Ph.D. Research Associate Professor Life Course Development Program The Institute for Social Research University of Michigan Ann Arbor, MI MedicalResearch.com Interview with: Kira S. Birditt, Ph.D. Research Associate Professor Life Course Development Program The Institute for Social Research University of Michigan Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Dr. Birditt: We know that negative marital quality (e.g., conflict, irritation) has important implications for physical health but the mechanisms that account for these links are still unclear. This study explored links between negative marital quality (e.g., criticism, demands), stress (long term chronic stresses) and blood pressure among older married couples in  a large longitudinal nationally representative sample of couples in the U.S..  We found that husbands had higher blood pressure when wives reported greater stress and that this link was even greater when husbands felt more negative about the relationship.  In addition, negative marital quality experienced by only one member of the couple was not associated with blood pressure but when both members of the couple reported higher negative marital quality they had higher blood pressure.  (more…)
Author Interviews, Genetic Research, OBGYNE / 08.04.2015

Jeanne M. Meck, PhD FACMG Director, Prenatal Diagnosis & Cytogenomic GeneDx Gaithersburg, MD 20877MedicalResearch.com Interview with: Jeanne M. Meck, PhD FACMG Director, Prenatal Diagnosis & Cytogenomic GeneDx Gaithersburg, MD 20877 Medical Research: What is the background for this study? Dr. Meck: Non-invasive prenatal screening (NIPS) for fetal aneuploidy is a new test which requires only a blood sample from the pregnant mother to provide a risk estimate of whether or not her fetus has a chromosomal aneuploidy such as trisomy 21 (Down syndrome), trisomies 13 or 18, or a sex chromosome abnormality. This testing relies on the fact that circulating maternal blood contains cell free fetal DNA. Published studies have reported very high specificities and sensitivities. However, the more important question is what is the positive predictive value (PPV= #true positive results/#true positive + false positive results) since it answers the question of interest to physicians and patients: “Given an Non-invasive prenatal screening result that shows a high risk for a given fetal aneuploidy, what is the chance that the fetus is affected?” We attempted to answer this question by looking at the results of fetal chromosome analyses on chorionic villus samples (CVS) or amniotic fluid that were referred to our cytogenetics laboratories after Non-invasive prenatal screening in order to see if NIPS correctly predicted the fetal karyotype. (more…)
Author Interviews, Cancer Research, Cost of Health Care / 08.04.2015

MedicalResearch.com Interview with: Stacie B. Dusetzina PhD Assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health University of North Carolina at Chapel Hill Member of the Lineberger Comprehensive Cancer CenterMedicalResearch.com Interview with: Stacie B. Dusetzina PhD Assistant professor in the Eshelman School of Pharmacy and the Gillings School of Global Public Health University of North Carolina at Chapel Hill Member of the Lineberger Comprehensive Cancer Center Medical Research: What is the background for this study? What are the main findings? Dr. Dusetzina: Charges for health services — the amounts providers request before payments are negotiated — have not been widely known for services delivered in physicians’ offices. Charges can be considered the maximum amount that would be paid by a person without insurance who does not or is unable to negotiate for a lower price. In this study we used recently released data from the Medicare Provider Utilization and Payment Public Use File and other sources to measure what physicians charged for chemotherapy drugs delivered intravenously in 2012 and the amounts reimbursed by Medicare and private health plans for the same services. We found that uninsured cancer patients may be asked to pay from 2 to 43 times what Medicare pays for chemotherapy drugs. Medicare and insurers don’t pay the sticker price of health care. They pay a discounted rate. However, uninsured patients don’t have the bargaining power, or they may not try to negotiate for a better price. On average, Medicare paid approximately 40 percent of the charged amounts for chemotherapy drugs. Private insurers paid nearly 57 percent of the charged amounts on average. We also looked at what cancer patients were asked to pay for an office visit. Uninsured patients may be asked to pay from $129 to $391, depending on the complexity of the visit. Medicare paid between $65 and $188 and private insurance paid between $78 and $246 for the same visits. (more…)
Author Interviews, Cancer Research / 08.04.2015

MedicalResearch.com Interview with: Dr. Riccardo Capocaccia Evaluative Epidemiology Unit Department of Preventive and Predictive Medicine Fondazione Istituto Nazionale Tumori Milan, Italy Medical Research: What is the background for this study? What are the main findings? Dr. Capocaccia: Life expectancy of cancer patients is usually provided at diagnosis, as a measure of cancer burden. However, no systematic data are available on life expectancy at different times after diagnosis, as a measure of the residual impact of the disease in survivors. At diagnosis, young patients face a higher loss in life expectancy, with respect to cancer-free people of the same age, than older ones. Thereafter, life expectancy gradually approaches, but hardly reaches,  that of all patients of the general population. (more…)
Author Interviews, Dermatology, HPV / 08.04.2015

MedicalResearch.com Interview with: Luis Squiquera, MD Tamir Biotechnology MedicalResearch: What is the background for this study? What are the main findings? Dr. Squiquera: Ranpirnase is a small peptide that has a characteristic enzymatic activity against double stranded RNA (dsRNA). As a drug it has been extensively tested intravenously in high concentration for oncology in over 1000 patients with different types of malignancy, especially mesothelioma, with minimal side effects and mainly a transient increase of serum creatinine level observed. In the last year we started a comprehensive antiviral program and obtained encouraging results in several RNA and DNA virus families. Several research groups have already studied the anti HIV activity. HPV was one of many viruses that showed a high selectivity index in our antiviral screening (the relationship between efficacy and cytotoxicity). We were encouraged by the low concentrations (nanomolar range) needed to stop virus reproduction in cell cultures. We performed in vitro analysis of two of the main HPV types that cause human disease (HPV 11 and 16). HPV 11 was highly sensitive to ranpirnase; and since this is one of the main virus type responsible for inducing genital warts, we decided to focus our efforts in bringing the drug to a new route of administration. We set out to obtain and did obtain a formulation that was extremely stable, even at high temperatures. Before using it in patients, we performed testing for irritation using standardized Draize animal models. Even though we ran these tests in high concentrations (1 mg/ml) the final product was not irritant and was deemed safe to use in a clinical setting. With these safety data on hand – plus extensive experience in IV dosing and non-irritation in animal models – we decided to make the formulation available as a compassionate use for patients with genital warts. As we reported in our presentation in San Francisco, all cases that completed an 8-week treatment showed clearance of the lesions. Some of the cases were cleared in as soon as two weeks and the average time for clearance was 33 days. One of the patients had to be discontinued due to an eczematous skin reaction. We will be studying the characteristic of this effect in our trials. (more…)
Author Interviews, Cognitive Issues, Memory / 07.04.2015

MedicalResearch.com Interview with: Dr. Lim Lee Wei School of Biological Sciences, Nanyang Technological University, Singapore; Department of Biological Sciences, Sunway University, Malaysia Medical Research: What is the background for this study? What are the main findings? Response: To date, pharmacological treatments for dementia have limited effects (most of the drugs failed in the second or third clinical trials) and there are no known treatments that cure or delay the progression of this memory impairment. Therefore, a novel non-pharmacological approach such as deep brain stimulation (DBS) is currently considered as an alternative treatment to reduce the symptomatic and progression of this memory deterioration. Deep brain stimulation for dementia-related disease is currently evaluated as a potential therapy. In line with this development, evidence from recent studies suggests that deep brain stimulation might enhance memory functions when particular brain areas are stimulated. Of particular interest in our study, electrical stimulation of the Prefrontal Cortex induced striking antidepressant activity in both patients and animals studies (see our recent study, Lim et al., 2015 Translational Psychiatry; http://www.nature.com/tp/journal/v5/n3/full/tp201524a.html). However, no studies have shown the putative role of Prefrontal Cortex deep brain stimulation in learning and memory performance. In our finding, we have shown that deep brain stimulation of this region (Prefrontal Cortex) improved the short-term and long-term memory by a very important mechanism, which led to the formation of new brain cells in another region of the brain called the hippocampus, which is also involved in memory. Therefore, our findings suggest that deep brain stimulation of the Prefrontal Cortex has the potential to be developed into a therapy to treat dementia and other conditions that lead to memory loss in humans. (more…)