Author Interviews, Brigham & Women's - Harvard, Dermatology, JAMA / 22.03.2015

Dr. Arash Mostaghimi, MD, MPA Director of Dermatology Inpatient Service Brigham and Women’s Hospital Boston, MAMedicalResearch.com Interview with: Dr. Arash Mostaghimi, MD, MPA Director of Dermatology Inpatient Service Brigham and Women’s Hospital Boston, MA     Medical Research: What is the background for this study? What are the main findings? Dr. Mostaghimi: Spironolactone, a generic drug that’s been used in the clinic since 1959, is commonly prescribed for treating hormonal acne – acne that tends to affect the jaw line most commonly around the time of the month when a woman gets her period. The US Food and Drug Administration recommends frequent potassium monitoring in patients with heart failure who are taking spironolactone as a diuretic and antihypertensive treatment, but it’s been unclear if these guidelines should apply to healthy patients taking spironolactone for the treatment of acne, and, if so, how frequently such patients should have their potassium levels tested. My colleagues and I have found that for young, healthy women taking spironolactone to treat hormonal acne, potassium monitoring is an unnecessary health care expense. For the approximately 1,000 patients we studied, blood tests to monitor potassium levels did not change the course of treatment, but the tests cumulatively totaled up to $80,000. We suggest that routine potassium monitoring should no longer be recommended for this patient population in order to improve the patient care experience, decrease unnecessary office visits and reduce health care spending. (more…)
Author Interviews, Dermatology / 22.03.2015

MedicalResearch.com Interview with: Nicolette Farman MD Ph.D. Directeur de recherche Université Pierre et Marie Curie, Paris, France Centre de Recherche des Cordeliers Paris, France Medical Research: What is the background for this study? What are the main findings? Dr. Farman: I have been working for a long time on aldosterone, a steroid hormone that enhances renal sodium transport, thus regulating blood pressure levels. Importantly, excessive effects of the hormone can be blocked by a pharmacological agent (a blocker of the receptor of the hormone): spironolactone. This drug has been used for decades as an anti-hypertensive drug. We identified several tissues where the receptor for the hormone (the mineralocorticoid receptor, MR) is expressed, in addition to kidney cells. Unexpectedly we found the receptor to be present in the human epidermis, but its role there was ignored. We designed first a mouse model, and found that overexpression of the receptor leads to thin and fragile skin in mice, as observed in glucocorticoid-treated skin. We hypothetized that perhaps the glucocorticoids exhibit this deleterious side-effect because they could bind to the mineralocorticoid receptor. As a consequence, we argued that pharmacological blockade of the MR over the skin should limit this side-effect. We used human skin explants in culture, and treated them with a potent dermocorticoid (clobetasol) alone or together with spironolactone. After 5 days in culture, we saw that spironolactone could indeed limit the atrophy of the epidermis induced by the dermocorticoid. Then a clinical trial was performed in healthy volunteers, that confirmed the efficiency of topical spironolactone to limit glucocorticoid-induced atrophy. Although the effect is not full reversion, the benefit was there. This is why we propose now that this approach could bring benefit to patients, if our results are confirmed in patients with psoriasis or eczema, that receive a dermocorticoid cream or gel. (more…)
Author Interviews, Dermatology / 22.03.2015

MedicalResearch.com Interview with: Steven R. Feldman, M.D., Ph.D. Professor of Dermatology Wake Forest Baptist Medical Center Winston-Salem, NC Medical Research: What is the background for this study? What are the main findings? Response: Results show that introducing apremilast into the treatment pathway prior to biologics is cost-saving and confers a cost and quality of life benefit. Over 10 years, apremilast was estimated to provide an additional 0.74 years (5.00 vs. 4.26 years) in which patients achieved a 75% reduction from baseline in PASI score, compared to a pathway of biologics only. It was also found to be less costly, mainly due to less time spent on more expensive biologic therapy (costs reduced by $9,072.39 over 10 years). (more…)
Author Interviews, University Texas, Weight Research / 22.03.2015

Helen P. Hazuda, Ph.D. Professor of Medicine Division of Nephrology Department of Medicine University of Texas Health Science Center at San Antonio San Antonio, TXMedicalResearch.com Interview with: Helen P. Hazuda, Ph.D. Professor of Medicine Division of Nephrology Department of Medicine University of Texas Health Science Center at San Antonio San Antonio, TX Medical Research: What is the background for this study? What are the main findings? Dr. Hazuda: The long-term effects of diet soda consumption on health outcomes is unclear, and studies in both humans and animals have raised concerns about their potentially harmful health effects including weight gain and increased cardiometabolic risk.  Most human studies have focused on middle-aged or younger adults, rather than focusing specifically on people 65 years and older, a rapidly growing segment of the U.S. population that has a disproportionately high burden of cardiometabolic disease and associated healthcare costs.  Therefore, our study examined prospectively the association between diet soda intake and long-term change in waist circumference in a biethnic cohort of older (65+ years)  Mexican American and European American participants in the San Antonio Longitudinal Study of Aging (SALSA). SALSA included a baseline examination (1992 – 1996) and three follow-up examinations (2000-2001, 2001-2003, and 2003-2004).  The total follow-up period averaged 9.4 years.  Diet soda intake, waist circumference (WC), height and weight were measured at each examination along with sociodemographic factors, leisure physical activity, diabetes mellitus, smoking, and length of follow-up. The main finding is that over the total 9.4-year SALSA follow-up period and after adjustment for multiple potential confounders, daily diet soda users (1+ diet sodas/day) experienced an increase in  waist circumference of 3.2 inches, while occasional diet soda users (>.05 < 1 diet soda/day) experienced a  waist circumference increase of 1.8 inches, and nonusers of diet soda experienced a WC increase of 0.8 inches.  Thus, there was a striking dose-response relationship between chronic diet soda intake and long-term increases in waist circumference. (more…)
Aging, Author Interviews, Education, NYU, Surgical Research / 21.03.2015

Uzma Samadani, MD, PhD Chief of Neurosurgery, New York Harbor Health Care System Assistant Professor, Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology Co-Director, Steven and Alexandra Cohen Veterans Center NYU Langone Medical CenterMedicalResearch.com Interview with: Uzma Samadani, MD, PhD Chief of Neurosurgery, New York Harbor Health Care System Assistant Professor, Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology Co-Director, Steven and Alexandra Cohen Veterans Center NYU Langone Medical Center Medical Research: What is the background for this study? What are the main findings? Response: The purpose of this study was to determine the current and future incidence of chronic subdural hemorrhage in the United States civilian and Veterans' Administration populations.  It's main findings are that, as the population ages, the incidence of subdural hemorrhage is increasing. (more…)
Author Interviews, Heart Disease, NEJM, NYU, UCSD / 20.03.2015

Sripal Bangalore, MD, MHA, FACC, FAHA, FSCAI, Director of Research, Cardiac Catheterization Laboratory, Director, Cardiovascular Outcomes Group, The Leon H. Charney Division of Cardiology, Associate Professor of Medicine, New York University School of Medicine, New York, NY 10016.MedicalResearch.com Interview with: 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 Medical Research: What is the background for this study? What are the main findings? Dr. Bangalore: Prior studies have shown a mortality benefit of bypass surgery over stenting. But these studies compared bypass surgery with older generation stents which are no longer used. We used data from the New York state registry of patients who underwent stenting or bypass surgery for 2 or more blockages of coronary arteries. With data from over 18,000 patients we found that there was no difference between stenting and bypass surgery for long term mortality. In addition we found that both procedures have trade offs. Bypass surgery has upfront risk of death and stroke whereas PCI has long term risk of needing a repeat procedure. In addition, in patients who underwent incomplete revascularization, there was increase in myocardial infarction with PCI. (more…)
Author Interviews, Heart Disease, Stroke, UCSD / 20.03.2015

Jonathan L. Halperin, M.D. The Robert and Harriet Heilbrunn Professor of Medicine Mount Sinai School of MedicineMedicalResearch.com Interview with: Jonathan L. Halperin, M.D. The Robert and Harriet Heilbrunn Professor of Medicine Mount Sinai School of Medicine Dr. Halperin is a member of the Steering Committee for the GLORIA-AF program and a consultant to Boehringer Ingelheim, which sponsored this research. Medical Research: What is the background for this study? What are the main findings? Dr. Halperin: The two analyses come from the GLORIA-AF Registry Program, a global, prospective, observational study supported by Boehringer Ingelheim, which is designed to characterize the population of newly diagnosed patients with non-valvular atrial fibrillation (NVAF) at risk for stroke, and to study patterns, predictors and outcomes of different treatment regimens for stroke risk reduction in non-valvular atrial fibrillation patients. The data is based on treatment trends in 3,415 patients who entered the registry from November 2011 to February 2014 in North America. All patients had a recent diagnosis of NVAF, and 86.2 percent had a CHA2DS2-VASc score of 2 or higher. Results from the first analysis demonstrated that patients with the paroxysmal (occasional) form of non-valvular atrial fibrillation and at a high risk for stroke (CHA2DS2-VASc score of 2 or higher) were given an anticoagulant medication less often than those with persistent or permanent forms of NVAF, and a CHA2DS2-VASc score of 2 or higher. This pattern runs counter to NVAF guidelines calling for patients to receive oral anticoagulant therapy based on their risk of stroke, rather than the type of atrial fibrillation. In the second analysis, researchers found that despite high stroke risk, a considerable number of patients receive only aspirin or no medication. (more…)
Author Interviews, Exercise - Fitness, Kidney Disease / 20.03.2015

Peter Kokkinos, PhD, FAHA, FACSM Veterans Affairs Medical Center Professor, Georgetown University School of Medicine George Washington University School of Medicine and Health Sciences Director, LIVe ProgramMedicalResearch.com Interview with: Peter Kokkinos, PhD, FAHA, FACSM Veterans Affairs Medical Center Professor, Georgetown University School of Medicine George Washington University School of Medicine and Health Sciences Director, LIVe Program Medical Research: What is the background for this study? Dr. Kokkinos: This is a prospective study and part of a larger cohort, the Veterans Exercise Testing Study (VETS) designed to assess the association between aerobic fitness and the risk of developing Chronic Kidney Disease or CKD. Our cohort included 5,812 middle-aged male Veterans from the Washington, DC Veterans Affairs Medical Center. All participants were CKD-Free prior to entering the study. Exercise capacity was assessed by a graded exercise test and peak Metabolic Equivalents or METs were determined. Accordingly, we established the following four age-adjusted fitness categories based on Quartiles of peak METs achieved: Least-fit (≤25%; 4.8±0.90 METs; n=1258); Low-fit (25.1%-50%; 6.5±0.96 METs; n=1614); Moderate-fit (50.1%-75%; 7.7±0.91 METs; n=1958), and High-fit (>75%; 9.5±1.0 METs; n=1436). Multivariable Cox proportional hazard models were used to assess the exercise capacity-CKD association. The models were adjusted for age, BMI, blood pressure, medications, CVD, Risk factors, race, and history of alcoholism. Medical Research: What are the main findings? Dr. Kokkinos: During a median follow-up period of 7.9 years, 1,000 individuals developed CKD. The CKD-fitness association was independent, inverse and graded. The CKD risk was 22% lower for every 1-MET increase in exercise capacity. When considering fitness categories, CKD risk decreased progressively as fitness status increased. Specifically, when compared to the Least-Fit individuals the risk of developing CKD was 13% 45% and 58% lower for individuals in the Low-Fit; Moderate and High-Fit categories, respectively. These findings support that higher aerobic fitness lowers the risk of developing CKD. The average exercise capacity necessary to realize these health benefits was just over 6.5 METs (Low-fit). This level of fitness is achievable by many middle-aged and older individuals by daily exercises such as brisk walking. Moderate intensity exercises are effective in improving aerobic fitness regardless of age or comorbidities. Thus, exercise interventions for individuals at risk for CKD and those with preclinical CKD may be implemented to prevent or at least attenuate the rate of developing CKD. (more…)
Aging, Author Interviews / 20.03.2015

Kamen Tsvetanov, PhD Centre for Speech, Language and the Brain Department of Psychology University of Cambridge Downing Street Cambridge, United KingdomMedicalResearch.com Interview with: Kamen Tsvetanov, PhD Centre for Speech, Language and the Brain Department of Psychology University of Cambridge Downing Street Cambridge, United Kingdom   Medical Research: What is the background for this study? What are the main findings? Dr. Tsvetanov: Older brains may be more similar to younger brains than previously thought! In our study we have shown that changes in the aging brain previously observed using functional magnetic resonance imaging (fMRI) – one of the standard ways of measuring brain activity – may be due to changes in our blood vessels, rather than changes in the activity of our nerve cells, our neurons. Given the large number of fMRI studies used to assess the aging brain, this has important consequences for understanding how the brain changes with age and it challenges current theories of ageing. (more…)
Alzheimer's - Dementia, Author Interviews, Johns Hopkins, Medical Imaging / 20.03.2015

Arnold Bakker, Ph.D. Assistant Professor Division of Psychiatric Neuroimaging Department of Psychiatry and Behavioral Sciences The Johns Hopkins University School of Medicine Baltimore, MD 21287MedicalResearch.com Interview with: Arnold Bakker, Ph.D. Assistant Professor Division of Psychiatric Neuroimaging Department of Psychiatry and Behavioral Sciences The Johns Hopkins University School of Medicine Baltimore, MD 21287 Medical Research: What is the background for this study? What are the main findings? Dr. Bakker: Patients who are at increased risk for developing dementia due to Alzheimer’s disease show hyperactivity in an area of the brain called the hippocampus, which is critically important for memory function. This study investigated the functional significance of this hyperactivity and determined if, similar to animal studies, treatment with low dose levetiracetam would reduce this increased activation and improve memory function in these patients. Results showed that this overactivity is a dysfunctional condition that contributes to the memory impairment such that treatment with very low doses of levetiracetam both reduces this overactivity and improves memory function in these patients. (more…)
Author Interviews, Kidney Disease, Lancet / 20.03.2015

Prof Vlado Perkovic MBBS PhD FASN FRACP George Institute for Global Health University of Sydney Sydney AustraliaMedicalResearch.com Interview with: Prof Vlado Perkovic MBBS PhD FASN FRACP George Institute for Global Health University of Sydney Sydney Australia   Medical Research: What is the background for this study? What are the main findings? Prof. Perkovic: There has been much discussion about the large number of people with kidney disease around the world- more than 10% of the population in most countries- but the current number of people with kidney failure had not been clearly defined. We therefore systematically collected information on the number of people with kidney failure around the world and found that 2.6 million people were receiving treatment for kidney failure in 2010, almost 80% of whom were undergoing dialysis while the others had received a kidney transplant. We then noticed very large differences in the number of people receiving treatment in different regions and countries, so used mathematical modeling to calculate the number of people who should be receiving treatment for kidney failure. The results of this analysis suggested there should be between 5 and 10 million people receiving treatment for kidney failure, suggesting that between half and three-quarters of people with kidney failure around the world died without access to dialysis, as a result of the high cost of dialysis treatment that is not affordable for many people around the world. These people are doomed to die of kidney failure, a condition for which we have had an effective treatment for over 50 years. (more…)
Author Interviews, MRSA, NEJM / 20.03.2015

Loren G. Miller, M.D., M.P.H. Los Angeles Biomedical Research Institute (LA BioMed) Infectious Disease SpecialistMedicalResearch.com Interview with: Loren G. Miller, M.D., M.P.H. Los Angeles Biomedical Research Institute (LA BioMed) Infectious Disease Specialist   Medical Research: What is the background for this study? Dr. Miller: Skin and skin structure infections are extremely common reasons for persons to seek medical care in the U.S., accounting for approximately 14.2 million outpatient visits in 2005, the latest year for which statistics are available, and 850,000 hospital admissions. Until this study was completed, the most effective approach to outpatient antibiotic treatment of uncomplicated skin infections in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) was unclear. Prior to this research, there were no data on which antibiotics were best for treatment of these common skin infections. Medical Research: What are the main findings? Dr. Miller: Two antibiotics frequently prescribed to treat serious skin infections - clindamycin and trimethoprim sulfamethoxazole (TMP-SMX) - had similar rates of success in curing uncomplicated infections in outpatients. They also had similar rates of side effects. To conduct the study, we recruited outpatients from emergency departments, clinics and other healthcare facilities associated with Los Angeles County's Harbor-UCLA Medical Center, University of Chicago Medical Center, San Francisco General Hospital and Vanderbilt University Medical Center from May 2009 to August 2011. We studied 524 adults and children with uncomplicated skin infections who had cellulitis, abscesses of 5 centimeters or more or both. In the multicenter, double blind, randomized clinical trial, 264 received clindamycin and 260 received TMP-SMX. We followed the outpatients for a month after their treatment. We found similar outcomes for both groups - 80.3% of the outpatients who received clindamycin and 77.7% of the outpatients in the group that received TMP-SMX were cured within seven to 10 days after the end of their treatment. These are not considered significant differences, so our evaluation is that these two commonly prescribed antibiotics for serious skin infections are similarly effective in treating uncomplicated skin infections in children and adults who have few or no major co-existing conditions. (more…)
Author Interviews, Case Western, Genetic Research / 20.03.2015

Jeff Coller, PhD Associate professor Division of General Medical Science Associate director, The Center for RNA Molecular Biology, Case Western Reserve University School of MedicineMedicalResearch.com Interview with: Jeff Coller, PhD  Associate professor Division of General Medical Science Associate director, The Center for RNA Molecular Biology, Case Western Reserve University School of Medicine MedicalResearch: What is the background of this study? Dr. Coller: There are a diverse number of half-lives for any individual messenger RNA (mRNA). The range of those half-lives is from seconds to hours. What the field has wanted to know for 30 years is how those rates are regulated, and there has been considerable anecdotal and real evidence that sequences in untranslated regions (UTRs) could regulate decay, but it doesn’t explain all of the half-lives that are observed for all messages. In addition, we have known mRNAs that are translated better are more stable than mRNAs that are translated poorly, so those pieces together led to the discovery. (more…)
Author Interviews, Melanoma, Wistar / 19.03.2015

Russel E. Kaufman, MD President Emeritus Professor, Molecular and Cellular Oncogenesis Program Molecular and Cellular Oncogenesis Program The Wistar InstituteMedicalResearch.com Interview with: Russel E. Kaufman, MD President Emeritus Professor, Molecular and Cellular Oncogenesis Program Molecular and Cellular Oncogenesis Program The Wistar Institute Medical Research: What is the background for this study? What are the main findings? Response: Targeted therapies in cancer were hailed as a “magic bullet” because of their ability to act upon the mutations responsible for cancer while leaving nearby healthy cells alone. Using an approach like this, it would make sense that therapies designed to target mutations of BRAFV600E/K could be effective for melanoma, since that gene is mutated in about half of all cases of the disease. However, we’ve learned over time that these targeted therapies simply aren’t as effective as we had hoped they would be. In the case of these BRAF inhibitors, while patients do live slightly longer, they eventually relapse within months of treatment. We wanted to know why this was happening. We decided to look at macrophages, which are the most abundant inflammatory cells in melanoma. The more macrophages present in a patient with melanoma, the worse his or her outcome will be. They’ve been linked to cancer progression, but before this study, no one had really looked at the role they may play in the resistance to treatment with BRAF inhibitors. We found that BRAF inhibitors activate the mitogen-activated protein kinase (MAPK) pathway in macrophages. When this pathway is activated, it leads to the production of vascular endothelial growth factor (VEGF), a signaling protein closely associated with angiogenesis. The VEGF produced in the macrophages is able to activate the MAPK pathway in melanoma cells, thereby stimulating the growth of cancer cells. Taking these findings one step further, we discovered that when we blocked the MAPK pathway or VEGF signaling, we appeared to reverse macrophage-mediated resistance. When we targeted macrophages, we were able to increase the antitumor activity of BRAF inhibitors in mouse and human models. (more…)
Author Interviews / 19.03.2015

Yuichiro Yano MD Dept of Preventive Medicine, Northwestern University, ChicagoMedicalResearch.com Interview with: Yuichiro Yano MD Dept of Preventive Medicine, Northwestern University, Chicago   Medical Research: What is the background for this study? What are the main findings? Response: Previous research has suggested that nocturnal blood pressure (blood pressure during sleep) is more predictive of cardiovascular events than daytime blood pressure. However, the effect of nocturnal blood pressure on cognitive function in midlife, especially for young adults, has not been studied before. The long-term clinical significance of the findings is that nocturnal blood pressure measurements in younger adults could be potentially useful to identify those who may be at risk for developing lower cognitive function in midlife. (more…)
Author Interviews, CDC, Nutrition, Pediatrics, Salt-Sodium / 19.03.2015

Joyce Maalouf MS MPH Nutrition Epidemiologist CDC, AtlantaMedicalResearch.com Interview with: Joyce Maalouf MS MPH Nutrition Epidemiologist CDC, Atlanta Medical Research: What is the background for this study? What are the main findings? Response: Although significant research shows U.S. children are eating too much sodium, data on the top dietary sources contributing to that intake is limited – particularly among babies and toddlers. This study identifies the primary sources of dietary sodium consumed by children from birth to 24-months-old, as well as differences in intake and food source broken down by demographic characteristics including age, gender and race/ethnicity. Overall, our research revealed that after the age of six months, more than 70 percent of sodium intake comes from foods other than breast milk and infant formula. Commercial baby foods, soups and pasta mixed dishes are top sodium contributors for U.S. infants 6 to 11.9 months, while soups, cheese, pasta mixed dishes and frankfurters and sausages are key contributors among toddlers aged 12 up to 24 months. Top sodium sources varied by race/ethnicity within age groups, suggesting that for sodium reduction to be effective, it needs to occur across a wide variety of foods. In addition, we found that non-Hispanic black toddlers ate more sodium than non-Hispanic white and Mexican-American children. Average sodium intake increased almost 9-fold from children under six months to those between one and two-years-old, while average energy intake only doubled. This suggests that, during the first two years of life, U.S. children increasingly consume sodium-rich foods. To determine these findings, we examined eight years of data encompassing more than 2,900 participants between birth and two-years-old. The information was pulled from the nationwide NHANES What We Eat in America survey between 2003 and 2010. (more…)
Author Interviews, Smoking / 19.03.2015

MedicalResearch.com Interview with: Uploaded by Merak MareyJonathan Thornburg, PhD Director, Exposure and Aerosol Technology RTI International Research Triangle Park, NC MedicalResearch: What is the background for this study? What are the main findings? Dr. Thornburg: RTI wants to improve the human condition by protecting public health from exposure to contaminants. That includes secondhand exposure to electronic cigarette vapors. RTI realized that most research has focused on the electronic cigarette user, not on secondhand exposure. Our research created a simulated lung in our laboratory to produce representative electronic cigarette aerosol that a user would exhale so we could measure the aerosol size distribution and chemical composition. Those two parameters are critical characteristics for understanding the physical and chemical properties of the aerosol as it disperses in the environment to produce the airborne concentrations that determine someone’s secondhand exposure. Our main findings were:
  1. The aerosol particles exhaled by a user are smaller than 1000 nm, with median size between 100 and 200 nm. The aerosol size distribution varies with the type of e-liquid used.
  2. The aerosol is made of water, glycerin/propylene glycol, nicotine, artificial flavors, and preservatives
  3. Artificial flavors identified were ethyl maltol, 2-methyl naphthalene and 2-tert-butyl-p-cresol present.
  4. BHA and BHT preservatives were present.
  5. Dosimetry modeling determined that more than 50% of the electronic cigarette emissions were exhaled by the user, potentially leading to secondhand exposure.
(more…)
AHA Journals, Author Interviews, Heart Disease, Pediatrics, University of Michigan / 19.03.2015

  Donald M Lloyd-Jones, MD/ScM Senior Associate Dean for Clinical and Translational Research Chair, Department of Preventive Medicine Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor Professor in Preventive Medicine-Epidemiology and Medicine-CardiMedicalResearch.com Interview with: Donald M Lloyd-Jones, MD/ScM Senior Associate Dean for Clinical and Translational Research, Chair, Department of Preventive Medicine Director, Northwestern University Clinical and Translational Sciences Institute (NUCATS) Eileen M. Foell Professor Professor in Preventive Medicine-Epidemiology and Medicine-Cardiology Northwestern University Feinberg School of Medicine MedicalResearch: What is the background for this study? What are the main findings? Dr. Lloyd-Jones: Previous studies have examined the associations of cardiovascular health, as defined by the American Heart Association, with outcomes in younger and middle-aged adults. Prior studies have also examined the status (i.e., prevalence) of cardiovascular health in adults across the age spectrum, and in adolescents ages 12-19 years. However, no study to date has examined the status of cardiovascular health in children under 12 years of age, so we sought to define it in detail using nationally-representative data. Overall, although we have inadequate surveillance systems to monitor cardiovascular health optimally in our youngest children, this study shows that there are concerning signals that they are losing the intrinsic cardiovascular health they are born with, even well before age 12 years. The implications for loss of cardiovascular health before adulthood have been well established, with earlier onset of cardiovascular diseases, cancer and other diseases, earlier mortality, lower quality of life and many other adverse consequences. (more…)
Author Interviews, Lancet, Mental Health Research / 19.03.2015

Dr. Angela WoodsMedicalResearch.com Interview with: Dr Angela Woods Associate Editor, BMJ Medical Humanities Journal Senior Lecturer in Medical Humanities Deputy Director, Centre for Medical Humanities Durham University   Medical Research: What is the background for this study? What are the main findings? Dr. Woods: We’ve known for a long time that hearing voices, or auditory hallucinations, is reported by people with a wide range of psychiatric diagnoses as well as by those who have no diagnosis. 5–15 per cent of adults will hear voices at some point during their lives – in circumstances that may be related to spiritual experiences, bereavement, trauma, sensory deprivation or impairment, as well as mental and emotional distress. However, what we know about voices clinically and empirically comes from a small handful of studies, typically conducted in mental health settings with patients with a diagnosis of schizophrenia using quantitative scales and measures. Our study asked people to describe, in their own words, what it is like to hear voices. We designed an open-ended online questionnaire which was completed by 153 people with a range of diagnoses, including 26 who had never had a psychiatric diagnosis. Our study found that a large majority of participants described hearing multiple voices (81%) with characterful qualities (70%). While fear, anxiety, depression and stress were often associated with voices, 31% of participants reported positive and 32% neutral emotions. To our surprise less than half the participants reported hearing literally auditory voices; 45% reported either thought-like or mixed experiences. Perhaps the most startling finding concerned the physicality of voices. Bodily sensations while hearing voices were reported by 66% of participants – these included feelings of tingling, numbness, burning, pressure, and a sense of being distanced or disconnected from the body. (more…)
Author Interviews, Lung Cancer, Radiology / 19.03.2015

MedicalResearch.com Interview with: Prof. Dr. Nikolaus Becker Epidemiologisches Krebsregister Baden-Württemberg Deutsches Krebsforschungszentrum Heidelberg Germany Medical Research: What is the background for this study? What are the main findings? Prof. Becker: Lung cancer is the leading cause of cancer death in our Western countries as well as worldwide. One reason is that it is clinically diagnosed mostly in an advanced stage with a poor five-year survival of less than 10%. Diagnosed at an early stage, more than 70% would survive 5 years. For low dose-multislice CT (MSCT) indications exist that it is able to detect lung cancers early. As every newly upcoming screening tool, it has to be carefully analyzed whether it is really able to decrease the mortality from lung cancers and at which costs in terms of undesired side effects such as false-positive findings and overdiagnosis. Our results indicate that spontaneous MSCT screening with changing doctors might be ineffective due to many false-positive alarms; if screening then within an organizational framework. (more…)
Author Interviews, Depression, Vitamin D / 18.03.2015

David C.R. Kerr Ph.D. Sch of Psychological Science Associate Professor College of Liberal Arts Oregon State UniversityMedicalResearch.com Interview with: David C.R. Kerr Ph.D. Sch of Psychological Science Associate Professor College of Liberal Arts Oregon State University Medical Research: What is the background for this study? What are the main findings? Dr. Kerr: Many people assume we already know that low levels of vitamin D contribute to depression, especially in winter. However, studies have not found consistent evidence for this, and most studies have focused on people in late life or with serious medical conditions. We focused on apparently healthy young women living in the Pacific Northwest. We found that women with low blood levels of vitamin D were more likely to report clinically significant depressive symptoms. This link existed even when we considered other factors that might explain both problems, such as diet, obesity, and time of year. (more…)
Author Interviews, Heart Disease, JACC / 18.03.2015

Prof. Ran Kornowski, M.D, FACC, FESC. Chairman - Division of Cardiology, Rabin Medical Center Petah-Tikva, IsraelMedicalResearch.com Interview with: Prof. Ran Kornowski, M.D, FACC, FESC Chairman - Division of Cardiology, Rabin Medical Center Petah-Tikva, Israel MedicalResearch: What is the background for this study? Prof. Kornowski: Over the years, the PCI procedure went-through many progresses. Among those are some angioplasty techniques, generalize use of stents and drug eluting stents, and adjuvant novel antithrombotic therapy. Unmistakably, these were associated with an overall improved PCI outcome. As many of the data on PCIs’ adverse outcomes predictors come from predates studies, we sought to update this matter. (more…)
Author Interviews, Heart Disease, Weight Research / 18.03.2015

Dr Rajeev Kumar Pathak MBBS, FRACP Cardiologist and Electrophysiology Fellow Centre for Heart Rhythm Disorders | University of Adelaide Cardiovascular Investigation Unit | Royal Adelaide Hospital Adelaide AustraliaMedicalResearch.com Interview with: Dr Rajeev Kumar Pathak MBBS, FRACP Cardiologist and Electrophysiology Fellow Centre for Heart Rhythm Disorders | University of Adelaide Cardiovascular Investigation Unit | Royal Adelaide Hospital Adelaide Australia Medical Research: What is the background for this study? What are the main findings? Response: Obesity and atrial fibrillation (AF) are dual epidemics that frequently coexist. Weight-loss reduces atrial fibrillation burden; however, whether this is sustained, has a dose effect or is influenced by weight-fluctuation is not known. In this study we evaluated the  long-term impact of weight-loss and weight-fluctuation on rhythm control in obese individuals with atrial fibrillation. (more…)
Author Interviews, Cognitive Issues, JAMA, University of Michigan / 18.03.2015

Donovan Maust, MD, MS Assistant Professor of Psychiatry University of Michigan Research Scientist, Center for Clinical Management Research VA Ann Arbor Healthcare SystemMedicalResearch.com Interview with: Donovan Maust, MD, MS Assistant Professor of Psychiatry University of Michigan Research Scientist, Center for Clinical Management Research VA Ann Arbor Healthcare System Medical Research: What is the background for this study? What are the main findings? Dr. Maust: From a recent government report, we known that about 1/3 of older adults with dementia in nursing homes and about 14% of those in the community have been prescribed an antipsychotic. While providers focus on what benefit the treatment they offer, it is important to also be aware of the potential harms, particularly when it is death. Prior estimates came from relatively short studies and showed a 1% increase. This paper finds that, over 180 days, the increased mortality comparing antipsychotic users to matched non-users is about 2 to 5 times higher. (more…)
Author Interviews, Exercise - Fitness, Lifestyle & Health, Weight Research / 18.03.2015

MedicalResearch.com Interview with: Sirpa Soini, MHC, researcher Department of General Practice and Primary Health Care University of Helsinki Medical Research: What is the background for this study? Response: Short-term weight loss is often successful, but he obtained results are difficult to maintain. Therefore, a study focusing on obese people who successfully lost weight, with special  emphasis upon methods applied and background factors, is of major importance. Many people are successful in losing weight by themselves without taking part in any organized group activity. The knowledge about their success and the methods applied does not usually reach the health care personnel and is one reason why it is difficult to get reliable information about those who are successful in losing weight. (more…)
Author Interviews, Brigham & Women's - Harvard, JAMA, Race/Ethnic Diversity, Surgical Research / 18.03.2015

Dr. Adil Haider, MD, MPH Kessler Director of the Center for Surgery and Public Health (CSPH) at Brigham and Women’s HospitalMedicalResearch.com Interview with: Dr. Adil Haider, MD, MPH Kessler Director of the Center for Surgery and Public Health (CSPH) at Brigham and Women’s Hospital Medical Research: What is the background for this study? Response: Disparities in the quality of care received by minority and low-income patients have been reported for years across multiple medical conditions, types of care, and institutions.  To determine whether clinicians’ unconscious race and/or social class biases correlated with a lower quality of care for minority patients and those of lower socioeconomic status, my colleagues and I conducted a web-based survey among 215 physicians at an academic, level one trauma center. Participants were asked to review eight clinical vignettes, and then respond to three questions about management of care after each. Following their response, a test known as an Implicit Association Test (IAT Test) was used to assess any unconscious preferences. Medical Research: What are the main findings? Response: We found that race and class biases, as measured by response time to a standardized Implicit Association Test, had no relationship to the way that patients were clinically treated. Whether the lack of association found between implicit bias and decision making in this study represents a true lack of association or the failure of clinical vignettes to capture the nuances of how implicit biases translate into management decisions remains unclear. Existing biases might influence the quality of care received by minority patients and those of lower socioeconomic status in real-life clinical encounters. (more…)
Author Interviews, Nature / 18.03.2015

MedicalResearch.com Interview with: Dr. Pak Kin Wong Ph.D. Aerospace& Mechanical Engineering Department Biomedical Engineering and Bio5 Institute The University of Arizona Medical Research: What is the background for this study? What are the main findings? Response: Collective cell migration is central to various (patho)physiological processes, such as tissue development, regeneration, and cancer metastasis. At the onset of the process, a subset of cells acquires distinct leader cell phenotypes in the initially homogeneous population and leads the migration. However, how leader cells are initiated among the initial homogeneous population and how leader cell density is regulated during collective migration remain unknown. In this study, we demonstrate the formation of leader cells is regulated dynamically by Dll4 signaling through Notch1 and cellular stress near the leading edge. Our finding provides a molecular basis for the stochastic emergence of leader cells, a process originally considered random. (more…)
Author Interviews, Breast Cancer, JAMA / 18.03.2015

Joann G. Elmore M.D., M.P.H. Professor of Medicine, Adjunct Professor of Epidemiology, University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104-2499MedicalResearch.com Interview with: Joann G. Elmore M.D., M.P.H. Professor of Medicine, Adjunct Professor of Epidemiology, University of Washington School of Medicine Harborview Medical Center Seattle, WA 98104-2499 MedicalResearch: What is the background for this study? What are the main findings? Dr. Elmore: It is estimated that 1.6 million women in the United States each year undergo a breast biopsy. By interpreting these biopsies under the microscope, pathologists provide diagnoses on a spectrum from benign, to atypia, to ductal carcinoma in situ (DCIS), to invasive cancer. Using these diagnostic classifications, clinical doctors work with their patients to decide if they are at increased risk of developing breast cancer in the future, which can lead to additional surveillance, or how to treat them when the diagnosis is invasive breast cancer. As misclassification of breast lesions by pathologists may contribute to overtreatment and undertreatment of breast disease, we decided to study the accuracy of breast pathology diagnoses in the U.S. In the Breast Pathology (B-Path) Study, we used a set of 240 breast biopsy cases to evaluate the interpretive accuracy of 115 U.S. pathologists who were actively interpreting breast biopsies in their clinical practices. Their diagnoses were compared with reference diagnoses established by a consensus panel of experienced breast pathologists. When the panel members each independently diagnosed the slides pre-consensus, they agreed unanimously on 75 percent of their diagnoses; ninety percent of the panel members’ initial independent diagnoses agreed with the final consensus-derived reference diagnoses. When comparing participating pathologists’ diagnoses to the reference diagnoses, we found overall agreement for 75 percent of interpretations. The concordance rate for invasive breast cancer was reassuringly high at 96 percent, and fairly high for benign findings without atypia at 87 percent. However, concordance was lower for atypia at 48 percent and for DCIS at 84 percent. This means that nearly one out of five pathologists disagreed on the diagnosis of DCIS. We found disagreement with the reference diagnosis to be statistically more frequent when pathologists had lower weekly case volumes or worked in smaller labs. Disagreement was also statistically significantly more likely when the patient had dense breast tissue on mammogram; however, the absolute difference was small. Our accuracy findings were not altered when we used different methods of defining the reference diagnosis. (more…)
Author Interviews, Infections, JAMA, University of Michigan / 17.03.2015

Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MIMedicalResearch.com Interview with: Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections. The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:
  1. Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
  2. Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
  3. Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.
Staff education emphasized precautionary measures against the spread of infection and included mock game shows, songs and dances. Hands were cultured for bacteria before and after hand washing. Outcomes were measured by results of the cultures taken for each patient and monitoring infection rates. A team of researchers from the University of Michigan and the Veterans Affairs Ann Arbor Health System has demonstrated that simple measures might be all it takes to push back at the spread of Multi-drug resistant organisms or ‘superbugs’ in nursing homes as well as reduce infections. In their study of patients with indwelling devices, MDROs were reduced by 23 percent among 418 residents in six southeast Michigan nursing homes who participated over the course of the three-year study. The numbers of catheter-associated urinary tract infections and MRSA acquisitions also decreased, 46 percent and 22 percent respectively. The trial examined the relationship between acquisition of antimicrobial resistance among nursing home and assisted living facility residents with the use of devices by adapting new methodological approaches and study designs to study infection prevention interventions including the use of cluster-randomized study design for infection prevention interventions, adopting adult learning practices to engage frontline healthcare personnel and using multi-anatomic site sampling to demonstrate effectiveness of the program. (more…)
Annals Internal Medicine, Author Interviews, CDC, Infections / 17.03.2015

MedicalResearch.com Interview with: Dr.Yecai Liu Division of Global Migration and Quarantine Centers for Disease Control and Prevention, Atlanta, Georgia Medical Research: What is the background for this study? What are the main findings? Response: Since the early 1900s, immigrants and refugees applying for a visa to come to the United States undergo a medical examination that includes tuberculosis (TB) screening. In 2007, CDC began implementing the new screening guidelines, which require people suspected of having TB to receive a much more sensitive sputum culture test to confirm TB to ensure that those individuals who do have TB receive treatment before they arrive in the United States. These requirements have now been completely rolled out to all countries with U.S.-bound immigrants and refugees. From 2007 through 2012, half of the 3.2 million arrivals of immigrants and refugees to the United States were screened for TB by the new screening guidelines. Out of more than 4,000 TB cases diagnosed by the new screening guidelines during this period, nearly 2,200 were smear-negative and culture positive. These cases would likely have been missed under the previous screening requirements. The results of this study showed that the updated overseas screening guidelines led to a roughly one-third decrease in the annual number of TB cases among foreign-born persons within their first year in the United States. (more…)