Author Interviews
26 Mar Anxiety Symptoms Raised by Air Pollution
MedicalResearch.com Interview with:
Melinda C Power, ScD
Post-Doctoral Research Fellow
Epidemiology Department, Johns Hopkins Bloomberg School of Public Health
Neurology Department, Johns Hopkins School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Power: Air pollution may be related to mental health, particularly anxiety, through effects on oxidative stress and systemic inflammation or through promotion or aggravation of chronic diseases. However, there has been very little research on the relation between air pollution exposures and anxiety in people. Our study found that those with higher exposures to fine particulate matter, a type of air pollution, were more likely to experience elevated anxiety symptom levels. Our study also suggests that recent exposures to find particulate matter air pollution are potentially more relevant to anxiety symptom levels than long-term past exposures.
26 Mar Imiquimod Cream May Be Effective In Primary And Adjuvant Treatment Of Lentigo Maligna
MedicalResearch.com Interview with:
Susan Swetter, MD
Professor of Dermatology and Director, Pigmented Lesion and Melanoma Program
Stanford University Medical Center and Cancer Institute.
Medical Research: What is the background for this study?
Dr. Swetter: This retrospective cohort study sought to explore the role of the topical immunomodular - imiquimod 5% cream - as both primary and adjuvant therapy (following optimal surgery) for patients with the lentigo maligna subtype of melanoma in situ. Assessment of alternative treatments to surgery for this melanoma in situ subtype are warranted given the increasing incidence of lentigo maligna in older, fair-complexioned individuals in the United States. Surgical management of lentigo maligna is complicated by its location on cosmetically sensitive areas such as the face, histologic differentiation between lentigo maligna and actinic melanocytic hyperplasia in chronically sun-damaged skin, and potential surgical complications in the elderly who may have medical co-morbid conditions.
Medical Research: What are the main findings?
Dr. Swetter: We conducted a retrospective review of 63 cases of lentigo maligna in 61 patients (mean age 71.1 years) who used topical 5% imiquimod cream instead of surgery (22 of 63 cases, 34.9%) or as an adjuvant therapy following attempted complete excision (63 cases, 65.1%), in which no clinical residual tumor was present but the histologic margins were transected or deemed narrowly excised. Our study showed overall clinical clearance of 86.2% in the 58 patients analyzed for local recurrence at a mean of 42.1 months of follow-up (standard deviation 27.4 months), with primarily treated cases demonstrating 72.7% clearance at a mean of 39.7 months (standard deviation 23.9 months), and adjuvant cases showing 94.4% clearance at a mean of 39.7 months (standard deviation 23.9 months). We found a statistically significant association between imiquimod-induced inflammation and clinical or histologic clearance in primary but not adjuvant cases, although this latter finding may be explained by a lack of residual atypical melanocytes or true LM in the adjuvant setting, in which wide local excision had already been performed.
26 Mar Prenatal Exposure To Air Pollutants May Produce Structural Brain Abnormalities
MedicalResearch.com Interview with:
Dr. Bradley S. Peterson, M.D
Director of the Institute for the Developing Mind
The Saban Research Institute of Children’s Hospital
Los Angeles Children’s Hospital Los Angeles
Medical Research: What is the background for this study?
Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7.
Medical Research: What are the main findings?
Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy. We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression. Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability.
26 Mar Air Pollution Linked To Increased Risk Of Stroke
MedicalResearch.com Interview with: Dr Anoop Shah Cardiology Research fellow Centre of Cardiovascular sciences University Of Edinburgh Edinburgh Medical Research: What is the background for this study? What are the main findings? Response: Stroke accounts for five million deaths each year and is a major cause of disability. The incidence of stroke is increasing, particularly in low and middle income countries, where two thirds of all strokes occur. The global burden of stroke related disability is therefore high and continues to rise. This has been primarily attributed to an aging population in high income countries and the accumulation of risk factors for stroke, such as smoking, hypertension, and obesity, in low and middle income countries. The impact of environmental factors on morbidity and mortality from stroke, however, might be important and is less certain. From 103 studies and across 6.2 million fatal and non-fatal strokes, our findings suggest a strong association between short term exposure to both gaseous (except ozone) and particulate air pollution, and admissions to hospital for stroke or mortality from stroke. These associations were strongest in low and middle income countries, suggesting the need for policy changes to reduce personal exposure to air pollutants especially in highly polluted regions.26 Mar Mental Health Issues Increase Hospital Readmissions
MedicalResearch.com Interview with:
Brian K. Ahmedani, PhD, LMSW
Research Scientist
Henry Ford Health System
Center for Health Policy & Health Services Research
Detroit, MI 48202
Medical Research: What is the background for this study? What are the main findings?
Dr. Ahmedani: The Centers for Medicare and Medicaid Services (CMS) have begun penalizing hospitals for excessive all-cause hospital readmissions within 30 days after discharge for pneumonia, heart failure, and myocardial infarction. We wanted to determine the influence of comorbid mental health and substance use conditions on the rate of 30-day hospital readmissions for individuals with these conditions. Overall, individuals with a comorbid mental health condition were readmitted to the hospital within 30-days approximately 5% more often than those without one (21.7% versus 16.5%). Comorbid depression and anxiety were associated with a 30-day readmission rate of more than 23% each, overall.
25 Mar Physician-Pharmacist Collaboration in Primary Care Offices Improved Blood Pressure Control
MedicalResearch.com Interview with:
Barry L. Carter, PharmD
Professor of Pharmacy
Professor of Family Medicine
U Iowa Carver College of Medicine
Medical Research: What is the background for this study? What are the main findings?
Response: Numerous studies and meta-analyses have found physician-pharmacist collaborative models can improve blood pressure (BP) control. In these models, pharmacists are located within primary care offices to assist with patient management. The physician delegates responsibility to pharmacists to perform a medication history, identify problems and barriers to achieving disease control, perform counseling on lifestyle modification and adjust medications following hypertension guidelines. However, it was not known if this model would be implemented in a large number of diverse primary care offices, if the effect could be sustained after discontinuation and if the intervention was as effective in under-represented minorities as in Whites. In this study, 32 clinics from throughout the U.S. were randomized to a 9 month intervention that was discontinued, a 24-month pharmacist intervention our usual care. All subjects received structured research measured blood pressure at baseline, 6, 9, 12, 18 and 24 months. We enrolled 625 subjects and 53% were from minority groups, 53% had < 12 years of education, 50% had diabetes or chronic kidney disease and 25% had Medicaid or self-pay for their care payments. All of these variables typically make it much more difficult to achieve BP control. BP control was 43% in the intervention groups and 34% in the control group at 9-months (adjusted OR 1.57 [95% CI 0.99-2.50], p = 0.059). However, when using the higher BP goals in the 2014 guidelines, blood pressure control was achieved in 61% of intervention subjects and 45% of control subjects at 9 months [(adjusted OR, 2.03 [95% CI 1.29-3.22], p=0.003). Of importance was the finding that the degree of systolic BP reduction (6 mm Hg) with the intervention compared to usual care was not only statistically significant but also the same in minority subjects (2/3 Black and 1/3 Hispanic) compared to all subjects. Interestingly, BP control seemed to be maintained in the subjects from minority groups at 18 and 24 months in both the group with the short (9-month) or sustained (24 month) intervention. In contrast, blood pressure control deteriorated slightly in non-minority subjects in all three groups.
25 Mar Tau Protein A Key Driver Of Cognitive Decline in Alzheimer’s disease
MedicalResearch.com Interview with:
Melissa Murray, Ph.D
Assistant Professor of Neuroscience
Mayo Clinic
Medical Research: What is the background for this study? What are the main findings?
Dr. Murray: Our study investigates two of the hallmark brain pathologies that underlie Alzheimer’s disease, abnormally accumulated tau and amyloid proteins. While both are integral to diagnosing Alzheimer’s disease postmortem, their exclusive relationship with cognitive decline has been debated. Using a large series from our brain bank we found that while an increase in abnormal accumulation of both proteins shares a close relationship with a decline in cognition, tau is the key driver of decline. This was important for us to understand as the second part of our study investigated amyloid brain scanning. We found that amyloid brain scanning closely represents amyloid deposits and not tau in postmortem brain tissue. One particular aspect we focused on is the cutoff for what would be a amyloid-positive brain scan that indicates Alzheimer’s disease. Our study supports that currently available cutoffs correspond to a level of amyloid accumulation that occurs before Alzheimer’s disease has too far advanced.
25 Mar Prostate Cancer: Does Timing of Radiation Therapy Affect Outcome?
MedicalResearch.com Interview with: Timothy N. Showalter, MD, MPH Associate Professor & Residency Program Director Department of Radiation Oncology University of Virginia School of Medicine Medical Research: What is the background for this study? What are the main findings? Dr. Showalter: Early radiation therapy has been shown to be an effective curative treatment for prostate cancer patietns with a rising PSA blood test after radical prostatectomy and for men with locally advanced prostate cancer who are at high risk of recurrence after prostatectomy. Despite evidence that radiation therapy is more effective when delivered early (or when the PSA is low), radiation therapy delivery is often delayed to allow more time for patients to recover urinary and sexual function. In order to provide evidence regarding whether delaying radiation therapy does reduce the risks of side effects of treatment, my colleagues and I evaluated outcomes of for a large cohort of patients who received treatment in the Emilia Romagna Region of Italy. We identified a total 0f 9,786 prostate cancer patients who received prostatectomy, including 22% of whom received post-prostatectomy radiation therapy. We found that earlier delivery of radiation therapy was not associated with increased risk of any adverse events, including gastrointestinal, urinary or sexual complications.25 Mar Electric Lights Disrupts Human Circadian Rhythm
MedicalResearch.com Interview with: Richard G. Stevens, Ph.D., Professor, Cancer Epidemiologist UConn Health Medical Research: What is the background for this study? What are the main findings? Dr. Stevens: Since first introducing the concept of a possible connection between exposure to light at night and breast cancer in the mid-80s, we’ve seen growing evidence of how artificial light can suppress the circadian hormone melatonin and bring about physiological changes. The extent of this “circadian disruption” varies by the type of light and the time of day. Humans evolved with a body clock that followed the solar clock. Nature intended us to be awake in daylight and at rest in the dark of night. Therefore, the intense, short-wavelength light of the sun in the morning triggers us to become awake and alert, just as the absence of sunlight in the evening allows our body to produce melatonin. Even with the use of fire to provide light in the evening, the circadian impact was relatively minimal because of firelight’s place on the red end of the visible spectrum. Humans survived under this simple formula for many thousands of years. Then electric light started to take an increasingly strong foothold in everyday life. Today we are typically surrounded at all hours of the day and night by artificial light – in many cases it’s not bright enough during the day to match the sun, and it’s too bright at night to be conducive to the natural sleep/wake cycle. Think computer screens, tablets, smart phones, e-readers, etc. These devices emit enough short-wavelength, or blue, light to disrupt our body clocks in the evening. So do fluorescent and LED lights. Our paper – I worked with Dr. Yong Zhu from Yale on this – represents a new analysis and synthesis of what we know up to now on the effect of lighting on our health. We don't know for certain, but there's growing evidence that the long-term implications of this may have ties to breast cancer, obesity, diabetes, and depression, and possibly other cancers. Exposure to electric light started about 130 years ago, which is a tiny period of time in evolutionary terms. In other words, not long enough to undo human evolution.25 Mar Pancreatic Stem Cells May Reverse Diabetes and Obesity
MedicalResearch.com Interview with:
Timothy J. Kieffer Ph.D. | Professor
Laboratory of Molecular & Cellular Medicine
Department of Cellular & Physiological Sciences
Department of Surgery | Life Sciences Institute
The University of British Columbia
Vancouver BC Canada
Medical Research: What is the background for this study? What are the main findings?
Dr. Kieffer: Previously we have examined the therapeutic potential of pancreatic precursor cells derived from human stem cells for insulin replacement in models of type 1 diabetes (PMID: 22740171 & PMID: 23771205). Here we sought to test the efficacy of cell-based insulin replacement in a model of type 2 diabetes, which is by far the most common form of diabetes. Key aspects of type 2 diabetes could be mimicked in immunodeficient mice, namely hyperglycemia and insulin resistance accompanied by excess body weight, by placing the mice on high fat diets. These diabetic mice were transplanted with human stem cell derived pancreatic precursor cells contained within macroencapsulation devices. The diabetic setting did not negatively impact the ability of the transplanted cells to mature into insulin-producing cells. Moreover, the cell transplants were able to significantly improve glucose homeostasis, particularly when combined with low doses of traditional anti-diabetic drugs. Intriguingly, the combined therapy also induced weight loss, such that treated mice were similar in weight to control mice reared on a low fat diet.
24 Mar Excellent Prognosis For Low Grade Localized Prostate Cancer In Elderly
MedicalResearch.com Interview with: Grace Lu-Yao, PhD, MPH, Professor of Medicine Cancer epidemiologist at the Cancer Institute of New Jersey Rutgers Robert Wood Johnson Medical School Medical Research: What is the background for this study? What are the main findings? Response: Prostate cancer is the most common non-skin cancer and the second most common cause of cancer death in the United States. Because of widespread prostate specific antigen (PSA) screening, most contemporary men are diagnosed with localized disease. Data from large well executed trials have shown improvement in overall mortality for men <65 years of age undergoing surgery for localized prostate cancer but no significant benefit for men 65 years of age or older. More than half of prostate cancer patients are diagnosed at age 65 or older. Despite that the majority of elderly patients with low-risk prostate cancer might be over-treated, only a small percentage of men in the United States have their prostate cancer managed conservatively. This study was undertaken to provide crucial long-term outcomes data so that prostate cancer patients can use these data for treatment decision.24 Mar Applying Lean Thinking Speeds Emergency Department Discharges
MedicalResearch.com Interview with:
Michael J. Beck MD, FAAP, SSGB
Department of Pediatrics
Milton S. Hershey Medical Center and the Pennsylvania State University College of Medicine, Hershey, Pennsylvania
Medical Research: What is the background for this study? What are the main findings?
Dr. Beck: Many hospitals are trying to improve patient discharge times. The benefits of this result will improve several valuable metrics within the organization’s value chain, namely improved access, reduced lost referrals, reduce emergency department boarding, to name a few.
As our region’s only tertiary care children’s hospital, that serves an expanding demographics and geographic population, access to our facility is becoming both a priority and challenge. Since many hospitals and hence hospital service lines work with a fixed number of beds, serving a growing population is going to lead to or exacerbate hospital access issues and emergency department boarding. The latter of which may carry financial penalties in the future based on Joint Commission standard LD 04.03.01 (revised 2013). We sought to applying elements of Lean and constraint theory, which postulate that flow can be created by eliminating waste, and that a process can move only as fast as its scarcest resource, respectively. From a lean perspective, why should “dischargeable” patients who were seen on AM work rounds still be occupying a valuable bed at 3 or 4PM when they were deemed safe for discharge hours earlier? Why should patients and organizations continue to tolerate this waste? Applying Lean thinking forced our service to reconfigure, re-sequence, and re-staff rounds in a way that could better meet patients’ and our organization’s needs and requirements. Since the discharge process output is an open bed, not having an open bed when it is needed, creates an organizational constraint. One constraint to creating an open bed, is the attending physician, ie a patient cannot be discharged until he/she is seen by the attending physician. However, another constraint is the model that one attending sees in excess of 13 patients per day (patient: provider ratio of 13:1). We hypothesized that by adding an attending to reduce the patient: provider ratio by 50% during predictable high volumes, we could do all of the discharge paperwork on rounds, at the time the decision to discharge is made by the attending. By advancing discharge order entry time, we should be able to advance the time patients get discharged, create an open bed earlier in the day, and ultimately reduce lost referrals and emergency department boarding.
Our service line median time of discharge order entry and time of patient discharge was compared to our own historical controls and to the same discharge behaviors of the remainder of our hospital services. The main intervention was staffing reallocation, creation of standard workflow expectations, and a discharge checklist. Finally, we also implemented a discharge huddle to occur before the day of anticipated day discharge.
Over the 6 month intervention period, the median time of discharge entry decreased from 2:05PM to 10:45 AM and the median time of patient discharge decreased from 3:58PM to 2:15 PM. The hospital control group did not change from baseline.
Our LOS went form 3.1 days to 3.0 days, and our 7, 14, and 30 day readmission rates did not increase. Emergency department boarding time was decreased by 30%, and lost referrals decreased 70% during the study period.
24 Mar More Asians and Hispanics Developing Non-Melanoma Skin Cancer
MedicalResearch.com Interview with: Arisa Ortiz, MD, FAAD Assistant Clinical Professor Director, Laser and Cosmetic Dermatology Senior author: Brian Jiang, MD and First author Tiffany Loh, BS Department of Dermatology UC San Diego Medical Research: What is the background for this study? What are the main findings? Response: Non-melanoma skin cancers (NMSCs) are the most common type of malignancy in the United States, affecting an estimated 3.5 million people each year. Previous perception has remained that skin cancer risk in Hispanics and Asians is lower than that of Caucasians. However, despite historically lower rates of skin cancer, in recent years, the incidence of skin cancer in these groups has reportedly been increasing in the United States. As Hispanics and Asians constitute two of the most rapidly expanding ethnic groups in the US, the rise in NMSCs in these populations is particularly concerning. The finding from our study were as follows: Hispanic patients were significantly younger than Caucasians and Asians (p=0.003, 0.023 respectively). The majority of Non-melanoma skin cancers in Caucasians occurred in men, while this gender ratio was reversed for both Hispanics and Asians. There were significantly more cases of Non-melanoma skin cancers occurring in the “central face” area in Hispanics. Race was not a significant predictor for specific NMSC type (BCC or SCC).24 Mar Women’s Sexual Desire May Be Sleep Dependent
MedicalResearch.com Interview with:
David A Kalmbach, PhD
Sleep and Circadian Research Laboratory
Department of Psychiatry
University of Michigan Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Kalmbach: As it happens, my research background is in sexual health, and my clinical work is in behavioral sleep medicine. Therefore, I've long been interested in the intersection between sleep and sexual response, though there has been little research in this area. With the growing recognition of a wide range of morbidities associated with poor sleep, coupled with the multifactorial etiology of sexual dysfunctions, I wanted to investigate whether sleep disturbance was associated with poorer sexual response. Using a 2-week daily diary approach in a sample of 171 young women, we found that longer reported sleep duration led to greater sexual desire the next day. This relationship was mirrored by finding that the likelihood of partnered sexual activity was increased following nights during which women slept longer. We also found an association between genital arousal and sleep length, though this relationship was more complex. Women reported greater vaginal arousal during sexual activity following nights of shorter sleep. However, women who slept longer on average reported better vaginal arousal than women who obtained less sleep on average. This dual relationship may reflect differential effects of a single night of sleep deprivations versus chronic sleep deprivation. However, I think more research is needed to delineate the underlying mechanisms of these relationships. Even so, I think it is notable that daytime sequelae of poor sleep (e.g., mood changes, fatigue) did not account for the relationships between sleep and sexual response.
24 Mar Electronic Records Facilitating Hospital Reporting Of Public Health Measures
MedicalResearch.com Interview with:
Dawn Heisey-Grove, MPH
Office of Planning, Evaluation, and Analysis
Office of the National Coordinator for Health Information Technology
U.S. Department of Health and Human Services
Washington, DC 20201
Medical Research: What is the background for this study?
Response: To complete outbreak investigations and perform tasks geared towards improving the public’s health, public health agencies need clinical information from hospitals and health care providers. Adoption of electronic health records (EHRs) and other health IT has made it possible to shift from time-intensive, paper-based public health reporting to electronic information exchange, which enables sending more complete information to public health agencies faster.
Such electronic information exchange with public health agencies is a component of the Medicare and Medicaid EHR Incentive Program meaningful use attestation process. Hospitals in the first stage of meaningful use must select at least one of three optional public health measures to report: immunization registry reporting, syndromic surveillance reporting, and electronic laboratory results reporting. Hospitals in the second stage of meaningful use are required to report on all three public health measures unless there is a valid exclusion.
Medical Research: What are the main findings?
Response: Using 2014 data from the Medicare EHR Incentive Program, we found that stage 2 hospitals were electronically reporting to local public health agencies more than stage 1 hospitals. Nationally, almost 75% of stage 2 hospitals were able to report all three measures to public health agencies, compared to only 5% of stage 1 hospitals. Stage 2 hospitals had very high rates for electronic exchange with public health agencies across all three measures. Specifically, immunization registry reporting among stage 2 hospitals was highest at 88%, 85% were electronically submitting lab results, and 75% successfully reported the syndromic surveillance measure.
24 Mar Obesity Paradox: Overweight Heart Failure Patients Have Best Prognosis
MedicalResearch.com Interview with:
Abhishek Sharma MD (on behalf of all co-authors)
Division of Cardiovascular Medicine
State University of New York Downstate Medical Center
Brooklyn, New York
MedicalResearch: What is the background for this study?
Authors: Heart failure (HF) is the second most common cause of hospitalization after child delivery in the US. In general, increasing degrees of obesity have been associated with progressively worse outcomes among individuals without known cardiovascular (CV) diseases. Therefore intentional weight loss, via structured dietary and exercise training programs or bariatric surgery, has been suggested to reverse hemodynamic and cardiac structural changes associated with obesity. However, several recent studies have reported lower mortality and morbidity among heart failure patients who were overweight or obese compared with those whose weight was normal or subnormal. This phenomenon has been commonly labeled the “obesity paradox” or “reverse epidemiology.” These findings question the prognostic significance of BMI and the practice of extrapolating findings derived from the general population to HF patients.
Reasons for the association between BMI and all- cause and CV mortality and hospitalizations in HF are not fully understood. Due to contradictory results in various studies and lack of definitive data on prognostic value of BMI and its purposeful alteration in HF, the American College of Cardiology Foundation/American Heart Association do not provide any firm recommendations for purposeful weight loss in heart failure. To further explore the relationship between obesity and outcome in heart failure patients, we systematically examined the association between BMI and all- cause mortality, CV mortality and hospitalizations among patients with chronic heart failure.
24 Mar Blood Test May Distinguish Osteoarthritis From Rheumatoid Arthritis
MedicalResearch.com Interview with:
Dr Naila Rabbani
Reader of Experimental Systems Biology
Protein Damage and Systems Biology Research Group, Division of Metabolic & Vascular Health, Warwick Medical School, University of Warwick,
Clinical Sciences Research Laboratories, University Hospital U.K.
Medical Research: What is the background for this study? What are the main findings?
Dr Rabbani: We performed a study to investigate biochemical markers indicative of early-stage decline in joint health and development of early-stage osteoarthritis OA), rheumatoid arthritis (RA) and other inflammatory joint disease. The main finding was that by combining measures of three substances in blood - citrullinated protein (CPs), antibodies to CPs and hydroxyproline we could detect and discriminate between early-stage osteoarthritis and rheumatoid arthritis.
24 Mar Opioid Analgesics Prescribed In Patients With Skin Disorders and Psychiatric Diagnoses
MedicalResearch.com Interview with:
Madhulika A. Gupta MD
University of Western Ontario
Medical Research: What is the background for this study? What are the main findings?
Dr. Gupta: Opioid (narcotic) analgesics (OA) are FDA-approved primarily for the symptomatic relief of pain in acute and chronic conditions. The prescription rates of Opioid analgesics in the US have increased significantly since 1989, and their possible inappropriate use has been declared a public health concern. We have recently reported (GuptaMA et al. J Dermatol Treat, 2014) that the use of Opioid analgesics in primarily skin disorders (with no reported non-dermatologic comorbidities) has increased from 1995-2010. Skin disorders are associated with psychiatric pathology in up to 30% of cases. Psychiatric disorders have been associated with an increased use of Opioid analgesics and other potentially addictive drugs. We examined psychiatric disorders, comorbidities and psychotropic drugs in patient visits with skin disorders and Opioid analgesics use (‘Skin Disorders+OA’).
We examined nationally representative cross-sectional data collected between 1995-2010 by the NAMCS and NHAMCS. Up to 3 ICD9-CM diagnoses are coded for each patient visit; the following codes were used to create the ‘Skin Disorders’ variable: ICD9-CM codes 680-709 ‘Diseases of the Skin and Subcutaneous Tissue’ and ICD9-CM codes 172, 173, 216 and 232 for cutaneous malignancies. Ambulatory Care Drug Database System drug codes were used for creation of variables for Opioid analgesics and other psychotropics.
23 Mar Stress Management Reduces Depression In Breast Cancer
MedicalResearch.com Interview with:
Michael H. Antoni, Ph.D.
Professor of Psychology and Psychiatry and Behavioral Sciences
Director, Center for Psycho-oncology Research
Program co-Leader, Cancer Prevention Control and Survivorship
Sylvester Cancer Center Sylvester Professor, Director Miami CTSI Pilot and Translational Studies Component University of Miami
Medical Research: What is the background for this study? What are the main findings?
Dr. Antoni: We have been conducting stress management intervention trials with breast cancer patients for the past two decades. We have shown that the form of stress management we developed, a 10-week cognitive behavioral stress management (CBSM) intervention, combining relaxation techniques, cognitive behavioral therapy techniques and coping and interpersonal skills training (assertiveness and anger management) delivered in a supportive group, can improve how women adapt during breast cancer treatment and up to one year later. These improvements in psychological status (less depressive symptoms, less negative mood and more positive mood) are associated with reductions in circulating serum cortisol levels, improved immune function and decreased inflammatory signaling over the first year of treatment. Since depressive symptoms are prevalent during cancer treatment our prior work showing that cognitive behavioral stress management reduces depressive symptoms over the 1st yr of treatment is significant . Since persisting depressive symptoms into survivorship are also common these new findings that women receiving cognitive behavioral stress management during primary treatment show beneficial effects out to 15 yrs suggests a real impact on their quality of life well into survivorship.
Further, since data just released this week at the American Psychosomatic Society meeting in Savannah, GA shows that depressive symptoms during breast cancer treatment predict greater odds of mortality over the next 8-15 yrs it is plausible that these cognitive behavioral stress management effects on reduced long-term depressive symptoms may have implications for survival. Finally since depressive symptoms relate to greater signs of inflammation in breast cancer patients and because inflammation promotes cancer disease progression via effects on angiogenesis, invasion and metastasis, then managing depressive symptoms during and after active treatment for breast cancer could have effects on health outcomes via lower inflammation.
23 Mar User-Generated Social Media May Reflect Hospital Quality
MedicalResearch.com Interview with:
Dr. McKinley Glover IV, MD, MHS Department of Radiology
Massachusetts General Hospital,
Harvard Medical School, Boston, MA
23 Mar Exercise May Be More Effective Than Vitamin D In Reducing Falls
MedicalResearch.com Interview with: Kirsti Uusi-Rasi, PhD, Adjunct Professor Senior Researcher UKK Institute for Health Promotion Research Tampere Finland Medical Research: What is the background for this study? What are the main findings? Dr. Kirsti Uusi-Rasi: Falls are the leading cause of unintentional injuries and fractures in older adults, head injuries and fractures being the most severe consequences. Therefore, falls prevention is important when trying to prevent injuries. There is strong high-quality evidence from previous studies that exercise that includes strength and balance training can reduce the risk of falling in older adults. However, there are also studies that have reported no benefit in reducing the actual incidence of falls. Effects of vitamin D have also been studied widely, and vitamin D is known to be vital for bone metabolism and health. However, results regarding effects on falls and fractures are inconsistent. Furthermore, persons with low vitamin D levels (serum 25OHD) have been associated with lower physical performance and greater decline in physical functioning, but clinical trials exploring the role of vitamin D in reducing falls and fractures and in improving physical functioning are inconclusive. Because there is hardly any evidence about exercise and vitamin D together, we investigated the separate and combined effects of multimodal exercise training and vitamin D supplementation in reducing falls and injurious falls among older women at risk for falling. We assigned 409 participants randomly to one of four groups with: 1)vitamin D 800 IU/day and exercise 2) placebo and exercise 3) vitamin D 800 IU/day without exercise 4) placebo without exercise. Exercise consisted of strength, balance, mobility and agility group training. At the end of two years, exercise seemed to be more effective in reducing injurious falls in this age group, with or without vitamin D. Exercise also improved physical functioning (strength, balance and mobility). In general, the training program was well tolerated with no severe adverse effects or injuries. Vitamin D helped maintain femoral neck BMD and increased trabecular bone density at the tibia. Our study also suggests that the current vitamin D recommendation (800 IU/d for older people) is adequate.23 Mar Trial of Current Dietary Guidelines Reduced Waistlines and Cardiovascular Risk Markers
MedicalResearch.com Interview with: Tom Sanders, PhD DSc Emeritus Professor of Nutrition & Dietetics, Diabetes and Nutritional Sciences Division, King’s College London London, UK Medical Research: What is the background for this study? What are the main findings? Dr. Sanders: Controversy surrounds the effectiveness of dietary guideline for cardiovascular disease (CVD) prevention in healthy middle-aged and older men and women. These dietary guidelines are similar in UK and other Western countries and focus on modifying the overall dietary pattern so that food and nutrient targets are met. However, surprisingly the overall impact of changing the dietary pattern has never been tested in a trial. We conducted a 12-wk controlled dietary trial in 165 healthy non-smoking men and women (aged 40-70 years) to compare a diet conforming to current dietary guidelines with a traditional nutritionally balance British diet on well established (blood pressure measured by 24-h ambulatory monitoring and blood lipids) and newer predictors of cardiovascular disease risk (measures of blood vessel functioning and stiffness, inflammation and the body’s sensitivity to insulin). The dietary guideline targets were to reduce total and saturated fat intake to provide no more than 35% and 10% of the food energy, to cut salt to below 6g/day, to meet the 5-a-day recommendation for fruit and vegetables, to consume at least 1portions of oily fish a week (i.e. mackerel, salmon, sardines), to obtain half of the cereal intake from wholegrains and to restrict intake of non-milk extrinsic sugar to no more than 10% energy. Subjects were counseled by a dietitian and provided with advice tailored to their individual food preferences and were provided with some foods to assist them following the dietary advice. The control diet was a nutritionally balanced traditional British diet without restriction on salt and sugar intake. It was based around refined cereals (white bread, pasta, breakfast cereals, white rice) and potatoes with meat (red meat, meat products or poultry), but with a limited intake of oily fish (less than once a month) and wholegrain cereals. Participants allocated to control were supplied with a butter-based spread and a liquid unhydrogenated vegetable oil (palm olein) that contained 40 % saturated fatty acids. They were advised to consume three servings of full-fat dairy products (milk, yogurt and cheese), and at least one serving of fruit and two servings of vegetables each day. Both groups were given advice to limit consumption of confectionery, snack foods (chips, cake, cookies) and drink alcohol within safe limits. Food intake records showed few differences in micronutrient intakes between diets with the exception of vitamin D where the intake and plasma 25-OH-vitamin D levels were greater on the dietary guidelines diet owing to the higher intake of oily fish. The average body weight in the group who followed the modified diet fell by 1.3 kg whilst that in the control group rose by 0.6 kg after 12 weeks, resulting in an overall difference in weight of 1.9 kg between the two groups; the equivalent difference in Body Mass Index (BMI) was 0.7 kg/m2 between the groups. Waist circumference was 1.7 cm lower in the dietary guidelines group compared to the control group. The drop-out rate was low, with 80 participants completing on the dietary guidelines diet and 82 on the control. Adherence to the dietary advice was confirmed both with dietary records and by measuring specific biomarkers in the participants’ blood and urine. The latter indicated an increase in potassium and fibre intake in the dietary group along with a drop in sodium (salt) and saturated fat and added sugar intake. However, total sugar intake remained unchanged owing to the increase in sugar intake from fruit. The primary outcomes were changes in day-time systolic blood pressure, endothelial function measured using the flow mediated dilation technique and total cholesterol: HDL cholesterol ratio. All other outcomes were secondary or exploratory outcomes. Significant falls in systolic blood pressure/diastolic blood pressure of 4.2/2.5 mm Hg for daytime and 2.9/1.9 mm Hg for night time were measured in the dietary group compared with the control group; the average heart rate was found to have lowered by 1.8 beats per minute. Causal mediated effects analysis based on urinary sodium excretion indicated that sodium reduction explained 2.4 mm Hg (95% CI 1.0, 3.9) of the fall in blood pressure There were no changes in endothelial dependent or endothelial independent vasodilation but arterial stiffness measured as carotid to femoral pulse wave velocity was 0. 29 m/sec lower on the dietary guidelines diet compared with the control diet. Total cholesterol:HDL cholesterol ratio was 4% lower on the dietary guidelines diet compared to the control low density lipoprotein and triglyceride concentrations were 10% and 9% lower respectively. The reduction in LDL-C (0.30 mmol/L) was greater than that achieved in most community based studies of dietary advice where the average reduction is 0.16 mmol/L but still modest compared with what can be achieved with statins (1.0 mmol/L). Compared with the control diet, the dietary guideline diet decreased low-grade inflammation (C-reactive protein). No significant change was recorded in markers for 24-h insulin secretion or insulin sensitivity, which predicts the risk of developing type 2 diabetes.22 Mar Acne: Potassium Monitoring May Not Be Necessary For Spironolactone Therapy
MedicalResearch.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.
22 Mar Topical Spironolactone May Limit Skin Thinning From Steroids
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.22 Mar Apremilast -Otezla -May Be Cost Effective For Psoriasis Treatment
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).22 Mar Diet Soda Linked To Increased Belly Fat and Waist Size
MedicalResearch.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.
21 Mar More Neurosurgeons Will Be Needed As Population Ages
MedicalResearch.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.
20 Mar Both Stenting and Bypass Surgery Reasonable For 2+ Blocked Coronary Arteries
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.
20 Mar Despite High Risk Of Stroke, Some Atrial Fibrillation Patients Not Adequately Anticoagulated
MedicalResearch.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.