MedicalResearch.com Interview with:
A/Prof Manuela Ferreira PhD
Senior Research Fellow, Musculoskeletal Division
Associate Professor, Sydney Medical School
The George Institute for Global Health Sydney AustraliaMedicalResearch: What is the background for this study? Dr. Ferreira: Our study was set up to look at the common triggers for sudden and moderate to severe episodes of back pain.
It included 1,000 participants with this condition. Participants were interviewed in the first week their pain episode occurred in and were asked to describe their physical and psychosocial activities in the 3 days preceding pain onset.
MedicalResearch: What are the main findings?Dr. Ferreira: The results of the study have shown that sudden attacks of back pain are more likely to be triggered in the morning, between 8 am and 11 am.
Being distracted while engaged in manual tasks, manual tasks performed in an awkward posture, or those involving objects not close to the body and lifting heavy loads were activities that most likely would trigger a new episode of back pain, even following very brief exposure (i.e. less than 2 hours). If you feel like this is you, you should visit a round rock chiropracter to aid progress!
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MedicalResearch.com Interview with:
Erin L. Kelly PhD Post Doctoral Scholar
Health Services Research Center
University of California, Los Angeles, California
MedicalResearch: What is the background for this study? What are the main findings?Dr. Kelly: Mental health facilities can be hazardous workplaces. Nationally, compared to their counterparts in other healthcare settings, mental health workers are at the highest risk for patient assaults. Many studies have focused on predictors for assault such as gender, years of experience, or the position that staff hold in the hospital, which can account for a small amount of violence. However, psychiatric care is largely about relationships. Our study examined how conflicts with patients and coworkers, and how people react to conflict, influences their risk of assault.
In our study, 70% of staff at a large public mental hospital were assaulted in a single year, which is closer to the lifetime assault rate for mental health workers. We also found that the likelihood of assault is predicted by conflicts when we also include stress reactions to conflict as a moderator. We found that workers who reported being less reactive to conflict but experienced a great deal of conflict, with staff or patients, were at the highest risk of assault. This could mean that people who aren't afraid of conflict with patients are more likely to jump in with agitated patients or that people who are insensitive to conflict are missing important social cues and being assaulted more often. However, despite the similarity in the relationships of staff conflict and patient conflict with assault risk, it’s possible that the direction of the relationship between staff conflict and assault may be different. For example, mental health staff who have a lot of conflict with their co-workers may be isolated and therefore a target for assault by patients.
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MedicalResearch.com Interview with:Tassaneewan Laksanasopin
PhD Candidate
Molecular and Microscale Bioengineering Lab
Columbia University
Medical Research: What is the background for this study? What are the main findings?
Response: We miniaturized and integrated all components needed for blood test (similar to ELISA) to be run on a smartphone accessory for point-of-care testing of infectious diseases. The device simultaneously detects three infectious disease markers for HIV, treponemal syphilis and nontreponemal syphilis from a finger prick of blood in just 15 minutes. In a blinded experiment in three health clinics in Rwanda, local health care workers obtained diagnostic results from 96 patients enrolled in prevention of mother-to-child transmission and voluntary counseling programs. The test performance from our triplexed test was 92-100% sensitivity and 79-92% specificity compared to the gold standard of lab-based HIV ELISA, Treponema pallidum haemagglutination and rapid plasma reagin. Importantly, patient preference for the dongle was 97% compared to lab-based tests, with most pointing to the convenience of obtaining quick results with a single finger prick. This work suggests coupling microfluidics with recent advances in consumer electronics can make certain lab-based diagnostics accessible to almost any population with access to smartphones.
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MedicalResearch.com Interview with:
Andres Moreno De Luca, MD
Investigator and Resident Physician
Autism & Developmental Medicine Institute
Department of Radiology Geisinger Health System
Danville, PA 17822
Medical Research: What is the background for this study? What are the main findings?Response: The main finding of our study is that family background contributes to the variability in cognitive, behavioral, and motor performance seen in children with 16p11.2 deletions, and perhaps other genetic syndromes, and this may be attributed in part to genetic background effects.
In the general population the best predictor of a child’s outcomes in traits such as cognitive ability, height, BMI, etc. is the biparental mean performance in such domains and this is due in part to genetic background. For example, if a child’s parents have IQ scores of 130 and 110, it is expected that the child will have an IQ within 2 standard deviations of 120 (bi-parental mean). However, when studying individuals with genetic conditions, most researchers tend to overlook the influence of familial/genetic background on the affected child’s outcomes and commonly attribute the manifestations (or lack thereof) to the genetic mutation alone.
This creates confusion when studying children with neurodevelopmental disorders, such as autism, which show significant clinical variability, as some children with a specific genetic mutation (e.g. deletion 16p11.2) may have intellectual disability without autism, while other children with the same mutation may have autism without intellectual disability. Based on these observations, some researchers have argued that deletion 16p11.2 is incompletely penetrant. However, our study showed that the 16p11.2 deletion has a detrimental effect on cognitive and behavioral performance for all children, but the clinical status (affected vs. unaffected) and ultimate performance level is influenced by the parental performance.
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MedicalResearch.com Interview with:
Torsten Olbers MD, PhD
Assistant Professor of Surgery
Sahlgrenska University Hospital
Gothenburg, Sweden
Medical Research: What is the background for this study? What are the main findings?
Dr. Olbers: Until now there has been no consensus regarding preferred bariatric procedure for patients with a body mass index (BMI) above 50 kg/m2. We report on the 5-year outcomes from a randomized clinical trial of gastric bypass and duodenal switch published online by JAMA Surgery on February 4th.
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MedicalResearch.com Interview with:
Ezequiel Morsella, Ph.D.
Associate Professor of Neuroscience Department of Psychology
San Francisco State University Assistant Adjunct Professor
Department of Neurology University of California, San Francisco
Boardmember, Scientific Advisory Board
Institute of Cognitive Neurology (INECO), Buenos Aires
Medical Research: What is the background for this study? What are the main findings?
Dr. Morsella: Previous studies have demonstrated that, under certain experimental conditions, conscious processes in the brain can function in a way that resembles reflexes. In past research, a single ‘high-level’ thought (e.g., the name of a visually-presented object) was triggered involuntarily by external stimuli. The current research is the first to trigger, not one, but two high-level unintentional conscious thoughts. In this experiment, participants were presented with an object (e.g., the picture of a star) and instructed to not subvocalize (i.e., name in one’s head but not aloud) the name of the object nor count the number of letters comprising the name of the object. On many trials, participants experienced both cognitions (e.g., “STAR” and “4”), even though these thoughts were against the intentions of the participant. Thus, this is the first demonstration of external control of two thoughts in the stream of consciousness. This research is based in part on the pioneering investigations of Wegner, of Gollwitzer, and of Ach.
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MedicalResearch.com Interview with:
Prof. Ran Kornowski, M.D, FACC, FESC on behalf of the coauthors
Chairman - Division of Cardiology,
Rabin Medical Center, Petah-Tikva, Israel
Medical Research: 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.
Medical Research: What are the main findings?
Prof. Kornowski: This study confirms the influence of advanced age, diabetes-mellitus and urgent settings (i.e. acute coronary syndromes) on PCI long term outcome. However, we found that their effect extent is modest while supplementary predictors such as anemia (even mild), chronic kidney injury and echocardiographic findings of left ventricular dysfunction have a greater effect on contemporary PCI prognosis.
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MedicalResearch.com Interview with:
Ashok K. Shetty, Ph.D.
Professor and Director of NeurosciencesInstitute for Regenerative Medicine and Department of Molecular and Cellular Medicine Texas A&M Health Science Center College of Medicine, Temple, TX Research Career Scientist, Central Texas Veterans Health Care System (CTVHCS), Temple, TX
Medical Research: What is the background for this study?
Prof. Shetty: Hippocampus is a region in the brain important for maintaining functions such as learning, memory and mood. However, this region is highly vulnerable to aging and brain insults. Previous research has shown that diminished function in the dentate gyrus region of the hippocampus is one of the key reasons for memory impairments seen in old age. Dentate gyrus is also one of the few regions in the brain where neural stem cells generate new neurons on a daily basis, also referred to as "adult neurogenesis". Studies have suggested that a significant fraction of newly born neurons mature, get incorporated into the existing hippocampus circuitry and contribute to learning, formation of new memories, and normal mood. However, with aging, the dentate gyrus shows decreased function with some conspicuous structural changes, which include reduced production of new neurons, diminished microvasculature implying reduced blood flow, and occurrence of hypertrophy of astrocytes and activated microglia, signs of chronic low-level inflammation. Because alterations such as reduced neurogenesis, decreased blood flow and brain inflammation can contribute to memory and mood impairments, the idea that drugs that are efficacious for mitigating these changes may preserve memory and mood function in old age has emerged. Such drugs may be prescribed to the aging population if they are efficacious for maintaining normal cognitive and mood function in old age with no or minimal side effects.
Medical Research: What is the rationale for choosing resveratrol for preventing age-related memory dysfunction in this study?Prof. Shetty: Administration of resveratrol, a naturally occurring polyphenol found in the skin of red grapes, red wine, peanuts and some berries, appeared suitable for counteracting age-related detrimental changes in the hippocampus. This is because, previous studies have shown that resveratrol has ability to promote the formation of new capillaries (through pro-angiogenic effects) and to suppress oxidative stress and inflammation (via antioxidant and antiinflammatory effects) with no adverse side effects. Other studies have also reported that resveratrol can mediate extension of the life span and delayed onset of age related diseases. More importantly, a recent human study suggested that a reasonably lower dose of resveratrol intake for 26 weeks is good enough to improve memory performance as well as hippocampus functional connectivity in 23 healthy overweight older individuals (Witte et al., J. Neurosci., 34: 7862-7870, 2014).
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MedicalResearch.com Interview with:
Ann Marie Navar-Boggan, MD PhD
Fellow, Cardiovascular Disease
Duke University School of MedicineMedical Research: What is the background for this study? What are the main findings?
Response: In this study of adults from the Framingham Offspring Study, we evaluated the impact of prolonged exposure to elevated cholesterol in early adulthood and future risk of coronary heart disease. In adults aged 55, the duration of time a person has been exposed to a non-HDL of >=160 mg/dL was associated with increased risk of coronary heart disease, and that risk was above and beyond the risk conferred by lipid levels at age 55. Every 10 years spent with a non-HDL of 160 or above was associated with a 39% increased future risk of coronary heart disease. We also looked at the association between prior average blood cholesterol between the age of 35 and 55, and found that every 10 mg/dL increase in prior average cholesterol above 125 mg/dL was associated with a 33% increased risk of coronary heart disease. These findings were particularly notable because the vast majority of adults with prolonged exposure to hyperlipidemia would not have been identified by the guidelines for statin therapy.
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MedicalResearch.com Interview with:
Adam E. Singer, MPhil
Pardee RAND Graduate School, RAND Corporation
Santa Monica, CA
MedicalResearch: What is the background for this study? What are the main findings?Response: In 1997, the Institute of Medicine (IOM) released a seminal report on the state of end-of-life care in the US that called for major changes in the organization and delivery of end-of-life care. Many of the IOM’s indictments have ostensibly been addressed since that time through the expansion of palliative care and hospice, along with a greater focus on symptom management in both policy and practice. This study was designed to ask whether end-of-life symptoms have become less prevalent from 1998 to 2010 for the population as a whole and also for subgroups that died suddenly or had cancer, congestive heart failure (CHF), chronic lung disease, or frailty.
The study found that many alarming symptoms were common in the last year of life and affected more people from 1998 to 2010. For example, in the whole population, pain affected 54% in 1998 and 61% in 2010 (a 12% increase). Depression affected 45% in 1998 and 57% in 2010 (a 27% increase). Periodic confusion affected 41% in 1998 and 54% in 2010 (a 31% increase). Depression and periodic confusion also became more prevalent in subgroups with CHF and/or chronic lung disease and frailty. In addition, nearly all other symptoms in the whole population and in each of the subgroups trended toward increases in prevalence from 1998 to 2010, although most of these trends did not reach statistical significance. The one exception is that there were no significant changes in the subgroup with cancer.
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MedicalResearch.com Interview with:
Jonetta L. Johnson, PhD, MPH
Epidemiologist
Division of Reproductive Health, CDC.
Medical Research: What is the background for this study?
Dr. Johnson: Achieving adequate gestational weight gain (GWG) is important for optimal health of the infant and mother. Women who gain below or above Institute of Medicine (IOM) recommendations are more likely to experience maternal complications and negative infant birth outcomes. Realizing the importance of gestational weight gain to maternal and infant health, the IOM established recommendations for gestational weight gain based on a woman’s prepregnancy body mass index (BMI) in 1990 and updated them in 2009. Trends in GWG are particularly of interest since prepregnancy BMI has increased over time in the U.S and little data was available on how gestational weight gain has changed over time.
Medical Research: What are the main findings?
Dr. Johnson: Our findings show that from 2000-2009, the majority of women did not gain weight within IOM GWG recommendations and that women were more likely to gain outside recommendations in more recent years. In fact, from 2000–2009, there was a gradual decrease (1.0 percentage point every 2 years) in women gaining within IOM gestational weight gain recommendations and a gradual increase (0.8 percentage points every 2 years) in women gaining above IOM recommendations while the percentage of women gaining weight below IOM recommendations remained relatively constant. Although there were slight differences in mean gestational weight gain by BMI group, gestational weight gain was about 31 pounds on average. The decreasing percentage of women gaining within IOM recommendations during our study period may be influenced by increases in prepregnancy BMI during the same time period because women in higher BMI groups are recommended to gain less weight during pregnancy compared to women in lower BMI groups. Thus, even with no change in gestational weight gain over time, an increase in the proportion of women who are obese could result in a decrease in the proportion of women gaining within gestational weight gain recommendations. (more…)
MedicalResearch.com Interview with:Dr Sandra L Jackson PhD
Atlanta VA Medical Center, Decatur, GA, Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences Emory University, Atlanta, GA, USA
Medical Research: What is the background for this study? What are the main findings?
Dr. Jackson: Lifestyle change programs are aimed to improve health, yet little is known about their impact once translated into clinical settings. The Veterans Health Administration (VA) MOVE! program is the largest lifestyle change program in the U.S. Participation is a key challenge of the program, as only 13% of the eligible population participated. However, among patients who did not have diabetes at baseline, we found that MOVE! participation was associated with lower diabetes incidence.
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MedicalResearch.com Interview with:Steven C. Hill, PhD
Center for Financing, Access and Cost Trends
Agency for Healthcare Research and Quality
Rockville, MD 20850
MedicalResearch: What is the background for this study? Dr. Hill: The Affordable Care Act offers two major ways to extend health coverage to more Americans: through expanding state Medicaid programs and through the Marketplace. States can expand Medicaid coverage to adults with family incomes at or below 138 percent of the federal poverty guidelines (approximately $16,242 for an individual and $33,465 for a family of four in 2015).
At the time of the study, 23 states had not yet expanded their Medicaid programs. In those states, poor adults typically continue to have very limited access to Medicaid. However, adults with incomes at or above the poverty guidelines who lack access to affordable insurance elsewhere are eligible for premium tax credits in the Marketplace. If these low-income adults purchase silver plans, then they are also generally eligible for cost sharing reductions.
MedicalResearch: What was the methodology for study? Dr. Hill: The study used data from then Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) to determine family out-of-pocket health care spending in 2005 – 2010 for uninsured, low-income adults who lived in the states that had not yet expanded Medicaid under the Affordable Care Act at the time of the study. The study focused on those who would have been eligible for Medicaid if their states expanded eligibility (income at or below 138 percent of poverty guideline), and whose incomes were high enough to be eligible for premium tax credits and cost sharing reductions through the Health Insurance Marketplace (at or above poverty guidelines). The study then compared those data with the following simulated scenarios for these adults: coverage in a Marketplace silver plan with financial assistance; and enrolling in expanded Medicaid.
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MedicalResearch.com
Hailey Winetrobe, MPH, CHES
Project Manager
NIDA Transitions to Housing Study
School of Social Work
University of Southern California
MedicalResearch: What is the background for this study? What are the main findings?Response: Homeless young adults are a very vulnerable population with high healthcare needs. However, because of their housing instability and very low income, many homeless young adults may not have health insurance and/or access to healthcare services. Prior research regarding this population’s health insurance coverage was mostly outdated. Additionally, with the implementation of the Affordable Care Act (ACA), homeless young adults may now qualify for health insurance coverage (i.e., if there is a relationship, by being a dependent on their parent’s health insurance until 26 years old; and via Medicaid expansion in states choosing to expand). As such, this study aimed to update homeless young adults’ rates of health insurance coverage prior to the full implementation of the ACA (i.e., before Medicaid expansion) and to determine if there was an association between insurance and use of healthcare services.
We found that 70% of homeless young adults did not have health insurance in the prior year. Of those with health insurance, 46% reported coverage through their parents, and 34% through Medicaid (not mutually exclusive). Over half (52%) of the sample received healthcare in the prior year. Furthermore, in a multivariable logistic regression model controlling for demographic characteristics, homeless young adults with health insurance, compared to their peers who did not have health insurance, had 11 times the odds of receiving healthcare in the prior year.
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MedicalResearch.com Interview with:
Pauline Mendola, PhD, Investigator
Epidemiology Branch
Division of Intramural Population Health Research
Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH
Rockville, MD 20852
Medical Research: What is the background for this study? What are the main findings?
Dr. Mendola: Asthma is the most common chronic disease in pregnancy and both asthma and maternal race/ethnicity are associated with adverse pregnancy outcomes. Since the prevalence of asthma also varies by race/ethnicity, we wanted to assess whether asthma was an important contributor to racial/ethnic disparities in pregnancy outcomes. We examined the joint impact of maternal race/ethnicity and asthma status on the risk of obstetric and neonatal outcomes.
In general, maternal asthma did not impact the risk of obstetric and neonatal complications within racial/ethnic groups. However, compared to mothers of the same race/ethnicity without asthma, White and Hispanic asthmatic mothers were more likely to have infants born small-for gestational age or admitted to the NICU. White women with asthma were also at increased risk of preeclampsia and maternal hemorrhage and Hispanic mothers with asthma were more likely to have infants with apnea. Despite their increased risk of maternal asthma and neonatal and obstetric complications, maternal asthma did not impact the risk of complications among Black women or their infants.
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MedicalResearch.com Interview with:
Christa Van Dort PhD
Department of Anesthesia, Critical Care, and Pain Medicine,
Department of Brain and Cognitive Sciences,
Picower Institute for Learning and Memory,
Massachusetts General Hospital, Harvard Medical School Boston, MA, 02114
Medical Research: What is the background for this study? What are the main findings?
Dr. Van Dort: Sleep is crucial for survival and maintenance of health. Inadequate sleep and sleep disorders impair many brain and body functions such as executive function, the immune system and memory consolidation. The benefits of sleep are dependent on normal sleep physiology and patterns. Natural sleep is composed of non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep alternating every 90 min in humans. Each stage provides different benefits, for example deep NREM sleep is associated with feeling rested and REM sleep is important for learning. Current sleep aids do not effectively restore normal sleep physiology or timing and as a result do not fulfill the important functions of natural sleep. To develop new strategies for reproducing natural sleep, we aimed to understand each component of sleep (NREM and REM sleep) individually and then in combination. Cholinergic neurons have been hypothesized to control REM sleep for many years but no one had been able to test this directly due to limited methodology. Optogenetics solved this problem by giving us the ability to activate selectively the cholinergic neurons in the pedunculopontine tegmentum (PPT) and laterodorsal tegmentum (LDT).
The primary finding of this study was that cholinergic neurons in the PPT and LDT are sufficient to drive REM sleep from NREM sleep. These cholinergic neurons were important for initiation of REM sleep but not the duration of REM sleep. Understanding REM sleep control is an important first step in reproducing normal sleep patterns and by itself could enhance learning and memory.
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MedicalResearch.com Interview with:
Ashley Di Battista, Ph.D.
Research Fellow
Critical Care Medicine| Neurosciences & Mental Health Program
The Hospital for Sick Children Toronto, ON, Canada
Medical Research: What is the background for this study? What are the main findings?
Dr.Di Battista: Most of what is known about adolescent quality of life (QoL) after traumatic brain injury (TBI) doesn’t come from adolescents – it comes from their parents. This profoundly non- concordant data (known as the “Proxy Problem”) is drawn from parent reported health-related quality of life (HRQoL) questionnaires (e.g. the PedsQL ™). Parent report can be influenced by the parents’ own distress after their child’s traumatic brain injury – which results in parents providing poorer estimates of their child’s QoL. Lack of insight is often purported to explain this difference, in the absence of direct examination of insight, or subsequent data, to support this claim. HRQoL has been criticized in the broader wellbeing literature as incompatible with the QoL construct– due to the absence of core features of the overall QoL model, and an inherent suggestion that a lack of overt pathology is equivalent to a good outcome.
Proxy reported, HRQoL focused research has generated a polarized view of quality of life after pediatric traumatic brain injury. This misrepresentation is due in part to the way in which we acquire this data (e.g. the tools) and who we ask (e.g. parents). The current study explored the individual adolescent experience of quality of life after traumatic brain injury and whether the tools commonly used to assess quality of life after brain injury are of capturing what adolescents define as relevant to their definition of quality of life.
Our findings revealed that when adolescents did endorse changes in functioning on the PedsQL, they did not consider these changes to be relevant to, or impact on, their self-described QoL. While the PedsQL™ is capable of documenting changes post-injury, it does not seem to capture domains of relevance to the adolescent idea of QoL. The ability of these adolescents to reflect on their own circumstances, engage in pre-to-post injury analysis of their functioning challenges default positioning that lack of insight is the sole determinant for differences in reports between proxies and adolescents on quality of life .
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MedicalResearch.com Interview with:
Barbara Grajewski, Ph.D., M.S., Epidemiologist Elizabeth Whelan, Ph.D., Branch Chief Christina Lawson, Ph.D., Epidemiologist
Division of Surveillance, Hazard Evaluations and Field Studies
National Institute for Occupational Safety and Health
Centers for Disease Control and PreventionMedical Research: What is the background for this study?
Response: The study, published January 5 online ahead of print in the journal Epidemiology, looked at potential workplace reproductive hazards for flight attendants. While in flight, flight attendants are exposed to cosmic radiation from space and, periodically, can be exposed to radiation from solar particle events. Flight attendants can also experience circadian disruption (disruption to the body’s internal time clock) from traveling across time zones and from working during hours when they would normally be asleep.
For this study, we analyzed 840 pregnancies among 673 female flight attendants and examined company records of 2 million single flights flown by these women. From these data, we estimated a marker of circadian disruption—working during normal sleeping hours—and exposure to cosmic and solar particle event radiation for each flight. This gives us a much more specific estimate of the exposures these workers face on the job every day. We also assessed the physical demands of the job, such as standing and walking for more than 8 hours a day and bending at the waist more than 25 times a day. Cosmic radiation and circadian disruption among flight attendants are linked very closely on many flights and are very difficult to look at separately when trying to understand what causes miscarriage. This is the first study that has attempted to separate these two exposures to determine which is potentially linked to miscarriage. This study is also an improvement over other studies in its assessment of cosmic radiation for each individual flight flown and from documentation of solar particle events. Earlier studies have looked at how many years a flight attendant has worked or other ways to estimate exposures that are not as specific.
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MedicalResearch.com Interview with:
Azfar-e-Alam Siddiqi, MD, PhD
Associate Chief of Science (Acting)
HIV Incidence and Case Surveillance Branch
Division of HIV/AIDS Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Centers for Disease Control and Prevention
Medical Research: What is the background for this study? What are the main findings?
Dr. Sidiqqi: African Americans remain the population most affected by HIV in the United States -- accounting for almost half (44 percent) of all new infections and more than a third (41 percent) of people living with HIV, despite representing just 12 percent of the U.S. population. We also know that far too many African Americans living with HIV do not get the medical care and treatment they need to stay healthy and protect themselves and others. In fact, less than half (40 percent) of African Americans living with HIV are engaged in care and only one-quarter (28 percent) have the virus under control through treatment.
To better understand mortality among African Americans with HIV, our team analyzed data from the National HIV Surveillance System for 2008 through 2012. Because immune suppression caused by HIV infection can result in fatal co-illnesses, our analysis estimated deaths due to all causes, rather than limiting their analysis to deaths resulting directly from HIV infection. This method allowed us to capture the fullest picture of mortality among African Americans with HIV.
According to our new analysis, from 2008-2012, the death rate per 1,000 blacks living with HIV decreased 28 percent, more than the overall decline (22 percent) observed among all persons living with HIV and more than declines observed among other races/ethnicities (13 percent for whites and 25 percent for Hispanics). Despite substantial declines in mortality, the death rate per 1,000 blacks living with HIV in 2012 was 13 percent higher than the rate for whites and 47 percent higher than the rate for Hispanics.
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MedicalResearch.com Interview with:
Erin R. Schlemmer, MPH
Health Care Manager / Epidemiologist
Department of Clinical Epidemiology & Biostatistics
Blue Cross Blue Shield of Michigan
MedicalResearch: What is the background for this study?Response: Low back pain (LBP) is a common reason for emergency department (ED) visits. Usually, uncomplicated acute LBP is a benign, self-limited condition that can be managed without the need for imaging studies. However, national data have shown that a substantial proportion of ED patients with LBP receive imaging studies, and that the use of advanced imaging has increased considerably for this population in recent years.
A number of groups (including specialty societies, a consortium of health plan medical directors, and an expert panel of emergency medicine physicians) have offered recommendations for the appropriate use of imaging for Low back pain. Within these guidelines, there are a number of “red flag” conditions that serve as indications for Low back pain imaging, and it is generally accepted that most patients do not require imaging to inform treatment of their Low back pain unless they have one or more red flags.
Our objective was to use claims data from a large commercial insurer to describe the imaging indications and imaging status of patients presenting to the ED with Low back pain, and to describe demographic and healthcare use characteristics associated with non-indicated imaging.
MedicalResearch: What are the main findings?
Response: We found that over half (51.9%) of all patients presenting to the ED with low back pain had no claims-based evidence of indications for imaging. Overall, 36.5% of patients received imaging, and 10.2% received advanced imaging (CT or MRI). Among patients with imaging indications, the most common indication was trauma (71.6%), followed by cancer (24.0%). Although nearly a third of non-indicated patients received imaging, this population had a lower prevalence of imaging compared to patients with imaging indications (30.1% vs. 43.5%), and were also less likely to have prior healthcare use (such as ED visits) in the past year. Among non-indicated patients who received imaging, 26.2% received advanced imaging (CT or MRI) and 4.3% had >1 type of imaging.
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MedicalResearch.com Interview with:Paula Iso-Markku, MD,
Department of Clinical Physiology and Nuclear Medicine,
HUS Medical Imaging Center,
Helsinki University Central Hospital and University of Helsinki
Helsinki , Finland
MedicalResearch: What is the background for this study? What are the main findings?Dr. Iso-Markku : The social, financial and humane burden of the dementia is extensive as the worldwide prevalence of dementia is estimated around 35.6 million. Finding efficient prevention strategies for dementia is crucial. Within the past decade vascular risk factors have been recognized as very potential risk factors of dementia. As physical activity is known to affect vascular risk factors, it might also be a potential preventive tool against dementia. Few comprehensive epidemiological studies on physical activity in middle age and dementia occurrence later in life have been conducted.
The comprehensive Finnish Twin Study offers a unique approach to the subjects as the shared growing up environment and genes can be taken into account. The study population is extensive and a good representation of the Finnish population. In this study the association of physical activity in adulthood and dementia mortality was investigated in a 29-year follow-up.
The main finding in this study was that persistent vigorous (i.e. more strenuous than walking) physical activity was significantly associated with lower dementia mortality. The results in the paired analysis, comparing twins to co-twins, were similar but remained non-significant. The analyses of the volume of physical activity were, however, controversial.
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MedicalResearch.com Interview with:
Meghan F. Davis, DVM MPH PhD
Assistant Professor
Department of Environmental Health Sciences
Johns Hopkins Bloomberg School of Public Health
Medical Research: What is the background for this study? What are the main findings?
Dr. Davis: Asthma rates have been on the rise, particularly in children. Interventions targeted at allergens and other environmental factors known to exacerbate asthma are only partially successful, suggesting a role for novel drivers of morbidity among existing patients with asthma. In this study, we evaluated associations between nasal colonization with the bacterium Staphylococcus aureus and symptoms related to wheeze and asthma using data from the nationally-representative NHANES database. We found that S. aureus nasal colonization was associated with asthma symptoms in children and young adults, but not in older adults.
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MedicalResearch.com Interview with: Professor Anne Barton FRCP PhD and
Dr John Bowes PhD
Centre for Musculoskeletal Research and
Centre for Genetics and Genomics,
The University of Manchester, Manchester UK
Medical Research: What is the background for this study?
Response: Psoriatic arthritis (PsA) is an inflammatory condition causing pain and stiffness in joints and tendons. Approximately one third of patients with psoriasis will go on to develop PsA resulting in a reduction in their quality of life caused by increasing disability and additional health complications. A key area of research within the Arthritis Research UK Centre for Genetics and Genomics in the Centre for Musculoskeletal Research is the identification of risk factors for the development of Psoriatic arthritis; this will allow us to understand the underlying cause of disease and ultimately help identify psoriasis patients at high risk of PsA, allowing early treatment to be introduced to reduce the impact of PsA.
Our study focuses on the identification of genetic risk factors for Psoriatic arthritis; we compared the frequency of genetic variants, referred to as single nucleotide polymorphisms (SNPs), between large numbers of DNA samples from patients with PsA and healthy control samples. When the frequency of the SNP is significantly different between cases and controls, the SNP is said to be associated with risk of developing Psoriatic arthritis and this association is interpreted as being important in the disease process.
Medical Research: What are the main findings?
Response: When we analysed the data from the study we found a new association to SNPs on chromosome 5, and when we investigated these SNPs for association with skin-only psoriasis, we did not find any evidence for association. In addition, we also found SNPs that were specifically associated with Psoriatic arthritis at a gene on chromosome 1. This gene is known to be associated with psoriasis, but our results show that there are different SNPs associated with PsA and psoriasis at this gene. Hence, our results identify new SNPs that are specifically associated with PsA.
In addition, identifying which cells are the key drivers of inflammation in Psoriatic arthritis will help us to focus on how the genetic changes act in those cells to cause disease. Our results show that many of the PsA associated SNPs occur in regions of the genome that are important in the function of CD8+ cells, an important cell type in the immune system.
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MedicalResearch.com Interview with: Jason R. Richardson MS,PhD DABT Associate Professor
Department of Environmental and Occupational Medicine
Robert Wood Johnson Medical School and
Resident Member
Environmental and Occupational Health Sciences Institute
Piscataway, NJ
MedicalResearch: What is the background for this study? What are the main findings?Dr. Richardson: Although ADHD is often though of as a genetic disorder, no single gene can explain more than a fraction of the cases. This suggests that environmental factors are likely to interact with genetic susceptibility to increase risk for ADHD. Our study reports that exposure of pregnant mice to relatively low levels of a commonly used pesticide reproduces the behavioral effects of ADHD in their offspring. Because the study was in animals, we wanted to see if there was any association in humans. Using data from the Centers for Disease Control and Prevention we found that children and adolescents with elevated levels of metabolites of these pesticides in their urine, which indicates exposure, were more than twice as likely to be diagnosed with ADHD.
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MedicalResearch.com Interview with:
Teresa W-M. Fan PhD and Andrew N Lane, PhD
Markey Cancer Center, University of Kentucky
Medical Research: What is the background for this study? What are the main findings?Response: The study began about eight years ago at the University of Louisville as a collaboration between thoracic surgeon Michael Bousamra II, immunologist Jun Yan and our metabolomics team (T. Fan, R Higashi and A.N. Lane) now at the U. Kentucky. Lung cancer remains as the highest cancer mortality in North America, and is unfortunately often not diagnosed until the most successful treatment, surgery, is no longer an option. Furthermore although there are numerous subtypes of the disease, the options for chemotherapy are quite limited. We wanted to know how the biochemistry of early stage (resectable) lung cancer differs from that of healthy or at least non-cancerous lung tissue from the point of view of basic tumor biology, and whether we might uncover better option for therapeutic intervention.
To this end, we applied our stable isotope resolved metabolomics (SIRM) technique directly to patients who were diagnosed with resectable NSCLC. By this technique, the fate of individual atoms from a non-radioactive enriched precursor (C-13 glucose in this instance) are traced as they are taken up from the blood and metabolized in situ. This technique, along with model studies with mice, isolated cell cultures, and so-called “Warburg” slices provides tremendous detail about the functional biochemistry of a cancer within its natural microenvironments, compared with non-cancerous tissue. The major finding published in this article is that the anaplerotic enzyme pyruvate carboxylase is greatly upregulated in NSCLC compared with paired non-cancerous lung tissue, whereas the other commonly utilized anaplerotic enzyme glutaminase was not. Interestingly, only cancer cells showed strong staining for pyruvate carboxylase, whereas in the paired non-cancerous lung tissue, only resident macrophages stained for PC. Pyruvate carboxylase was further shown to be essential for tumor growth in both call culture and in mouse xenografts.
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MedicalResearch.com Interview with: Joanna Holbrook PhD
Senior Principal Investigator - Systems Biology
Singapore Institute for Clinical Sciences
Brenner Centre for Molecular Medicine
Singapore
Medical Research: What is the background for this study?
Dr. Holbrook: Bacteria in the human gut may influence many aspects of our health; however, it is not fully known what determines the composition of the gut microbiota. Rapid bacterial colonisation of the infant gut could be influenced by the environment of the baby before birth, and microbiota content has been associated with the development of obesity and insulin resistance.
Medical Research: What are the main findings?Dr. Holbrook: The rate of bacterial colonisation of the gut is influenced by external factors such as the method of delivery and duration of gestation. Also, infants with a mature gut bacteria profile at an early age gained normal levels of body fat, while infants with less mature gut bacteria profiles displayed a tendency to gain lower levels of body fat at the age of 18 months, indicating that gut bacteria could be related to normal development and healthy weight gain.(more…)
MedicalResearch.com Interview with:
Ingvild Saltvedt PhD
Department of Neuroscience, Norwegian University of Science and Technology,
Medical Faculty Trondheim, NorwayMedical Research: What is the background for this study? What are the main findings?
Dr. Saltvedt: Hip fracture patients are often old, frail and have many comorbidities. When treated with a traditional orthopaedic approach the outcomes are often poor, and many patients get functionally impaired with reduced ability to walk independently and impairment in daily life activities and with high costs for the society. In many ways these patients are geriatric patients with hip-fractures. It has previously been shown that acutely sick geriatric patients benefit from treatment in geriatric wards and different kind of orthogeriatric treatment models where orthopaedic surgeons and geriatricians collaborate have been studied and have shown beneficial results on short term outcomes. In the present study patients home-dwelling hip-fracture patients were randomised to orthogeriatric treatment or traditional orthopaedic treatment from admission to the hospital and during the entire stay except for the surgery that was performed similar in both groups. The study focused on long-term outcomes and also on use of health care services and cost-effectiveness. Patients in the orthogeriatric group got comprehensive geriatric assessment and treatment performed by an interdisciplinary team that emphasised early mobilisation and rehabilitation and started discharge planning early. In the orthopaedic group traditional treatment according to national and international guidelines was offered.
The primary endpoint was mobility at four months, that was better in the orthogeriatric group than in the orthopaedic group, the same difference was also shown at 12 months. In addition there were differences in instrumental activities of daily living and personal activities of daily living, quality of life and fear of falling, all differences were statistically and clinically significant and in favour of the orthoegeriatric group. The length of hospital stay was 1,7 days longer in the geriatric group, while there was no differences in days spent in hospital during one year of follow-up. One of four orthogeriatric patients were discharged directly home as compared to one of ten in the orthopaedic group. The orthopaedic group spent more days in nursing homes and rehabilitation institutions during one year of follow-up. The treatment was cost-effective in favour of the orthogeriatric group.
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MedicalResearch.com Interview with:
V. Zlokovic, MD, PhD
Professor and Chair
Department of Physiology and Biophysics
Keck School of Medicine of USC.
Medical Research: What is the background for this study? What are the main findings?
Dr. Zlokovic: Our team used high-resolution imaging of the living human brain to show for the first time that the brain’s protective blood barrier becomes leaky with age, starting at the hippocampus, a critical learning and memory center that is damaged by Alzheimer’s disease.
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MedicalResearch.com Interview with:
Ya-lin (Aileen) Huang, PhD.
Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
Atlanta, GA, 30329
Medical Research: What is the background for this study? What are the main findings?
Dr. Huang: With an estimated 50,000 new HIV infections each year in this country, and no vaccine or cure available yet, prevention is critical. Maximizing the impact of all available prevention strategies could significantly reduce new infections in this country. The purpose of this study is to provide evidence for the cost effectiveness of the interventions recommended under the funding announcement and to highlight where more cost-effectiveness studies may be needed. We limited our scope to the four interventions required under the health department funding announcement, including HIV testing, prevention with HIV-positives and their partners, condom distribution and efforts to align policies with optimal HIV prevention, care and treatment.
Our review provides an updated summary of the published evidence of cost-effectiveness of four key HIV prevention interventions recommended by CDC: HIV testing, prevention with HIV-positives and their partners, condom distribution and policy initiatives. Models suggest that more than 350,000 HIV infections have been avoided because of the nation’s HIV prevention efforts. In addition to lives saved, HIV prevention has also generated substantial economic benefits. For every HIV infection that is prevented, an estimated $402,000 (http://www.ncbi.nlm.nih.gov/pubmed/23615000) is saved in the cost of providing lifetime HIV treatment. It is estimated that HIV prevention efforts have averted more than $125 billion in medical costs since the beginning of the epidemic. (more…)
MedicalResearch.com Interview with:
Michael Wilson, MD, PhD, FAAEM
Attending Physician, UCSD Department of Emergency Medicine
Director, Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) lab UC San Diego Health System
MedicalResearch: What is the background for this study? What are the main findings?Dr. Wilson: Emergency departments (EDs) nationwide are crowded. Although psychiatric patients do not make up the largest proportion of repeat visitors to the emergency department, psychiatric patients stay longer in the ED than almost any other type of patient. So, it’s really important to find out things about these patients that may predict longer stays.
In this study, we looked at patients on involuntary mental health holds. The reasoning is simple: patients on involuntary mental health holds aren’t free to leave the ED. So, the only thing that should really matter is how quickly an Emergency department can release them from the involuntary hold. Surprisingly, though, this wasn’t the only thing that correlated with longer stays.
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MedicalResearch.com Interview with:
A/Prof Manuela Ferreira PhD
Senior Research Fellow, Musculoskeletal Division
Associate Professor, Sydney Medical School
The George Institute for Global Health
Sydney Australia
MedicalResearch: What is the background for this study?
Dr. Ferreira: Our study was set up to look at the common triggers for sudden and moderate to severe episodes of back pain.
It included 1,000 participants with this condition. Participants were interviewed in the first week their pain episode occurred in and were asked to describe their physical and psychosocial activities in the 3 days preceding pain onset.
MedicalResearch: What are the main findings?
Dr. Ferreira: The results of the study have shown that sudden attacks of back pain are more likely to be triggered in the morning, between 8 am and 11 am.
Being distracted while engaged in manual tasks, manual tasks performed in an awkward posture, or those involving objects not close to the body and lifting heavy loads were activities that most likely would trigger a new episode of back pain, even following very brief exposure (i.e. less than 2 hours). If you feel like this is you, you should visit a round rock chiropracter to aid progress!
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