MedicalResearch.com Interview with:
Carl "Chip" Lavie MD, FACC
Medical Director, Cardiac Rehabilitation and Prevention
Director, Exercise Laboratories
John Ochsner Heart and Vascular Institute
Professor of Medicine
Ochsner Clinical School-UQ School of Medicine
Editor-in-Chief, Progress in Cardiovascular Diseases
Medical Research: What are the key points of your editorial?Dr. Lavie:
1) The importance of higher fitness to predict a lower rate of developing Heart Failure;
2) improvements in fitness over time predict a lower rate of developing Heart Failure, and
3) Once Heart Failure develops, higher fitness predicts a more favorable prognosis.
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MedicalResearch.com Interview with:
Matthew D. Ritchey, DPT
Division for Heart Disease and Stroke Prevention
US Centers for Disease Control and Prevention, Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?Dr. Ritchey: This study analyzes the contribution of heart disease subtypes – such as coronary heart disease, heart failure, hypertensive heart disease and arrhythmia – to overall trends in heart disease death rates between 2000 and 2010. Our research revealed that overall heart disease-related deaths declined during that time frame at a rate of almost four percent annually. Most of this decline appears to be driven by decreases in coronary heart disease mortality, which includes deaths due to heart attacks.
However, not all heart disease subtypes saw similar decreases. Arrhythmia and hypertensive heart disease death rates increased annually during this period. In addition, there were differences depending on age group, subtype, gender and race/ethnicity. For example, hypertensive heart disease rates were much higher (more than double) among non-Hispanic blacks in 2010 than among non-Hispanic whites. That could be due to factors including uncontrolled blood pressure and obesity among younger adults. Also, the increase in arrhythmia mortality was highest among non-Hispanic whites, women and adults age 75 and over. That increase might be linked to the growing aging population, the result of individuals living longer with heart failure, increases in chronic kidney disease and hypertensive heart disease prevalence and changes in how the condition is reported.
To determine these findings, we examined de-identified death certificates of U.S. residents ages 35 and up who died from 2000 to 2010. The data was pulled from the CDC WONDER database, which contains death certificate information from every U.S. state and the District of Columbia.
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MedicalResearch.com Interview with:Sheila E. Harvey, Ph.D.
CTU Manager/Senior Research Fellow
ICNARC
Napier House London
Medical Research: What is the background for this study? Dr. Harvey: The CALORIES trial was set-up in the context of concerns about malnutrition in critically ill patients in NHS hospitals and conflicting evidence as to the optimal route for delivery of early nutritional support to critically ill patients. The enteral route is the mainstay of nutritional support in the critically ill but it is frequently associated with gastrointestinal intolerance and underfeeding. In contrast, the parenteral route, though more invasive and expensive, is more likely to secure delivery of the intended nutrition but has been associated with more risks and complications (e.g. infectious complications) compared with the enteral route.
In light of the uncertainty surrounding the most effective route for delivery of early nutritional support and, given recent improvements in the delivery, formulation and monitoring of parenteral nutrition, the UK National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Programme put out a “call” for a large pragmatic randomised controlled trial to be conducted in critically ill patients to determine the optimal route of delivery of early nutritional support. CALORIES was set up to test the hypothesis that early nutritional support delivered via the parenteral route is superior to early nutritional support delivered via the enteral route in adults who had an unplanned admission to an intensive care unit and who could be fed via either route.
The primary outcome was all-cause mortality at 30 days. The secondary outcomes included infectious and non-infectious complications (hypoglycaemia, elevated liver enzymes, nausea requiring treatment, abdominal distension, vomiting, new or substantially worsened pressure ulcers).
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MedicalResearch.com Interview with:
Dr. Eloisa Colin-Ramirez, BSc, PhD and
Justin A. Ezekowitz, MBBCh MSc
Associate Professor, University of Alberta
Co-Director, Canadian VIGOUR Centre
Director, Heart Function Clinic
Cardiologist, Mazankowski Alberta Heart Institute
Medical Research: What is the background for this study? What are the main findings?
Response: The SODIUM-HF study is a randomized control trial on sodium restriction in patients with chronic heart failure (HF). Sodium restriction has been broadly recommended as part of the self-care strategies in heart failure yet is based on little high-quality evidence. This study reports the results of the pilot SODIUM-HF trial in 38 patients with chronic HF. Nineteen patients were prescribed a low sodium containing diet (1500 mg/day) and 19 a moderate sodium containing diet (2300 mg/day). Both interventions were based on a structured and individualized meal plan to achieve the targeted sodium intake, and all patients were followed for 6 months with monthly phone call to reinforce adherence to the diet.
We found a meaningful reduction in sodium intake to less than 1500 mg/day at 6 months in both groups. Additionally, we observed that patients that achieved a sodium intake less than 1500 mg/day at 6 months of follow-up had reduced BNP levels, a biomarker of volume overload and surrogate prognostic marker in heart failure, and increased overall and clinical scores of the Kansas City Cardiomyopathy Questionnaire, compared to those with a sodium intake greater than 1500 mg/day.
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MedicalResearch.com Interview with: Lauren Marie Sparks, PhD
Faculty Scientist at the Translational Research Institute for Metabolism and Diabetes
Florida Hospital and the Sanford-Burnham Medical Research Institute Orlando, FL
Medical Research: What is the background for this study? What are the main findings?Dr. Sparks: As a clinical scientist focused on exercise effects on muscle metabolism in diabetes, I have seen first-hand a significant minority of individuals with diabetes not improve their glucose control (HbA1c) after 9 months of supervised exercise. They poured their hearts out on those treadmills 3-4 days a week for 9 months and still ended up no better than when they started. I have also seen similar data from some of my colleagues’ studies. So I really want diabetes research to invest the intellect and dollars into discovering what these roadblocks are—I happen to believe it is in the DNA (genetics) and the way that DNA is “read” or expressed (epigenetics). So it’s a bit of a ‘call to action’ for researchers to start looking into some of their data to find these people and better understand this phenomenon and for hopefully the funding sources to recognize this as a viable area of research.
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MedicalResearch.com Interview with :
Alexandra Laurent
Maître de conférences de psychologie clinique et psychopathologie
Laboratoire de psychologie EA3188
Université de Franche-Comté
Medical Research : What is the background for this study? What are the main findings?Dr. Laurent: Human error among healthcare professionals is a subject of current affairs and especially in ICUs which are among the services with a high risk of error. If the error affects the patient and his/her family, it will also have an impact on the caregivers involved, their colleagues, and even the entire service. In an editorial in the BMJ, Wu introduced the term “the second victim” to define a caregiver implicated in and traumatised by an medical error for which he/she feels personally responsible. Therefore, it’s important to improve understanding of the psychological repercussions of error on professionals in ICUs, and to identify the defense mechanisms used by professionals to cope with errors.
In the month following the error, We found that the professionals (doctors and nurses) described feelings of guilt and shame. These feelings were associated with: anxiety states with rumination and fear for the patient; a loss of confidence; an inability to verbalize one’s error; questioning oneself at a professional level; and anger towards the team.
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MedicalResearch.com Interview with:
Christina Nelson, MD, MPH, FAAP
Medical Epidemiologist
Centers for Disease Control and Prevention
Division of Vector-Borne Diseases | Bacterial Diseases Branch
Fort Collins, CO
Medical Research: What is the background for this study? Dr. Nelson: Evidence-based guidelines for the diagnosis and treatment of Lyme disease have been provided by the Infectious Diseases Society of America for many years. These comprehensive guidelines have been vetted by external review panels as the best option for patient care. In endemic areas, patients with the typical rash (erythema migrans) can be diagnosed with Lyme disease clinically. Otherwise, the guidelines recommend that diagnosis be based on a history of possible exposure, compatible clinical features, and positive two-tier serologic testing.
Some patients who have been treated for Lyme disease may develop post-treatment Lyme disease syndrome (PTLDS) – fatigue, arthralgias, or other symptoms that persist after completing antibiotic treatment. Although the exact cause of post-treatment Lyme disease syndrome is unknown, it is thought to be due to an altered immune response or residual damage to tissues during the acute infection. A diagnosis of exclusion, PTLDS should only be diagnosed after the patient has been thoroughly evaluated and other potential causes of symptoms ruled out.
On the other hand, “chronic Lyme disease” is a loosely defined diagnosis that has been used to describe a variety of ailments. A small cadre of providers use unconventional methods to diagnose patients with chronic Lyme disease, and sometimes there is no objective evidence that the patient ever had Lyme disease. Multiple factors contribute to this phenomenon, including misconceptions about serologic testing, use of unvalidated diagnostic tests, and clinical diagnosis of Lyme disease based on nonspecific symptoms alone.
We know that patients have been – and continue to be – harmed by treatments for chronic Lyme disease. Patients have suffered from emboli, severe allergic reactions to antibiotics, neutropenia, and infections such as Clostridium difficile. This is terrible and should never happen. However, there is another important danger related to these alternative practices. Some patients who have been diagnosed and treated for chronic Lyme disease later discover that another condition is the root of their physical problem. We wanted to highlight some of these cases in order to help educate providers and patients about this issue.
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MedicalResearch.com Interview with:James J. DiNicolantonio, PharmD
Associate Editor BMJ Open Heart
Cardiovascular Research Scientist
Saint Luke's Mid America Heart Institute
Medical Research:What is the background for this study? What are the main findings?Dr. DiNicolantonio: Focusing on calories misdirects eating away from healthy foods (that are higher in calories - such as nuts, salmon, and avocados) and towards harmful foods (e.g. rapidly absorbable carbohydrates - including added sugars such as table sugar and high fructose corn syrup).
Treating obesity should not focus on decreasing caloric intake, rather, it should focus on eating quality foods. Lower calorie foods - that are high in rapidly absorbable carbohydrates - drive increased hunger throughout the day, whereas higher calorie foods (such as full-fat milk and eggs) leads to satiety. Consuming rapidly absorbable carbohydrates leads to increased total caloric intake throughout the day (driven by insulin resistance and leptin resistance). These metabolic consequences derived from overconsuming these types of foods leads us to eat more and exercise less. In essence, eating more and exercising less doesn't cause obesity, overconsuming rapidly absorbable carbohydrates causes us to eat more and exercise less, which then causes obesity - a subtle but important distinction.
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MedicalResearch.com Interview with:
Priv.-Doz. Dr. med. Dr. phil. Martin Ebinger
Center for Stroke Research Berlin (CSB)
Charité - Universitätsmedizin Berlin | CCM
Berlin | Germany
Medical Research: What is the background for this study? What are the main findings?
Response: Hitherto, little has been known about the effects of thrombolysis (tPA) in ischemic stroke within the first 60 minutes of symptom onset. That's because the so-called golden hour thrombolysis is such a rare event. As James Grotta, Houston, Texas, recently pointed out there were only 2 patients receiving tPA within 60 minutes in the pivotal NINDS trial - both received placebo, and even the latest up-date on randomized trials of tPA includes only two further patients within 60 minutes. In our study, we used the Stroke Emergency Mobile (STEMO) for ultra-early thrombolysis in the pre-hospital setting. STEMO is a specialized ambulance equipped with a CT scanner, point-of-care laboratory, and a telemedicine connection to neuroradiologist on call. Aboard the STEMO, there is a paramedic, a radiology technician and a neurologist. The project was initiated und supervised by Heinrich Audebert from the Charité, Berlin, Germany.The main finding of our study is that we showed a statistically significant association between golden hour thrombolysis and discharge home as opposed to e.g. nursing facilities.
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MedicalResearch.com Interview with
Dr. Jonathan Myles
Centre for Cancer Prevention, Queen Mary, University of London
Wolfson Institute of Preventive Medicine, Charterhouse Square, London
Medical Research: What is the background for this study? What are the main findings?Dr. Myles: Breast cancer screening uptake is low in areas of high social deprivation and large populations of some ethnic groups. The main finding of this study is that an intervention in the form of contacting women by telephone a few days before the date of their screen, reminding them of their appointment and answering any queries they may have, significantly increases uptake.
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MedicalResearch.com Interview with:
Dr. Martin Thornhill PhD
Department of Cardiology, Taunton and Somerset NHS Trust
Taunton, Somerset, UK
Medical Research:What is the background for this study? What are the main findings?Dr. Thornhill: In 2008 NICE introduced controversial new guidance recommending that antibiotic prophylaxis to prevent infective endocarditis should no longer be used. It was a rational decision, given the evidence for the effectiveness of antibiotic prophylaxis and potential concerns about costs, the development of antibiotic resistance and possible side effects from antibiotics, but it went against other guidelines from around the world that existed at the time.
The main findings are that in England:
There has been a large and significant decline in the use of antibiotic prophylaxis.
There has been a significant increase in the number of cases of infective endocarditis, above the baseline trend, using hospital coding data, corrected for changes in the size of the English population.
MedicalResearch.com Interview with:
Naveed Nosrati MD
Indiana University School of Medicine
Staff Surgeon, Roudebush VAMC
Medical Research: What is the background for this study? Dr. Nosrati: We originally began this study as a broader project investigating the effect of trauma induced by biopsies on the spontaneous clearance of a non-melanoma skin cancer. As part of that, we created a large database with many patient variables. Since we undertook this project at our local VA hospital, one of the variables available to us was Agent Orange exposure.
Shortly after completing the study, Clemens et al published their study linking Agent Orange exposure to higher rates of invasive non-melanoma skin cancer. Their study was a pilot study of only 100 patients. As we had well over 1,000 patients, we decided to pursue a side project of how Agent Orange specifically affects our results.
Our study was operating under the hypothesis that trauma induced by biopsies led to an inflammatory response that often led to the immunologic clearance of the remaining skin cancer. We actually coined the term “SCORCH” lesion, or spontaneous clearance of residual carcinoma histologically, for this phenomenon. With that mind, we would expect patients exposed to Agent Orange to theoretically have a more invasive form of malignancy and thus have lower rates of spontaneous clearance.
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MedicalResearch.com Interview with:
Dr. Jennifer Marin MD MSc
Director of Emergency Ultrasound
Division of Pediatric Emergency Medicine
Assistant Professor of Pediatrics and Emergency Medicine
University of Pittsburgh School of Medicine
Medical Research:What is the background for this study? What are the main findings?
Dr. Marin: Overuse of diagnostic imaging in the emergency department has become a focus of concern from policy makers, patients, and physicians. There are evidence-based clinical decision rules and policy recommendations published in order to optimize the use of such imaging. However, physicians don't necessarily use these tools in their decision-making. Head computed tomography (CT) imaging for patients with minor head trauma is a common CT performed in the emergency setting. Our study sought to evaluate how often physicians adhered to the American College of Emergency Physicians (ACEP) Clinical Policy on Neuroimaging. The policy outlines which patients warrant a CT in the setting of minor head trauma based on certain factors, such as age, mechanism of injury, and signs and symptoms of head trauma. What we found is that when the policy recommends that a head CT be performed, it is obtained more than 90% of the time. However, when a head CT is not recommended, it is actually obtained in nearly half of those patients. We hope this will draw attention to decision rules and clinical policies, such as that from ACEP, and remind physicians that using these tools can assist in appropriate imaging practices.
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MedicalResearch.com Interview with:Karin B. Michels, ScD, PhD
Associate Professor of Obstetrics, Gynecology and Reproductive Biology
Harvard Medical School
Medical Research:What is the background for this study? What are the main findings?Dr. Michels: We were interested in studying the long-term effects of oral contraceptive use on mortality. Given the widespread use of oral contraceptives, this is an important question pertaining to millions of women worldwide. We explored this question in the large Nurses’ Health Study, a cohort of 121,700 women in the US, who have been followed for 38 years. We found that oral contraceptive use does not impact overall mortality. However, breast cancer mortality was slightly increased, especially with long-term use of oral contraceptives.
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MedicalResearch.com Interview with:
Ralitza P. Parina, MPH, Senior medical student
John Rose, MD MPH
Department of Surgery at University of California San Diego
Medical Research:What is the background for this study? What are the main findings?Response: This study looked at the association between hospital 30-day readmission rates and 30-day mortality rates. While readmission rates are coming into increasing focus with CMS reimbursement cuts for hospitals with higher than expected rates, they remain a poorly studied metric of quality. High readmission rates have been unequivocally tied to increased costs, but it remains unclear whether they actually represent poor quality of care and worse outcomes for patients. We chose to compare readmission rates as a quality metric to the well-established “gold standard” of mortality.
We found that 85% of hospitals did not show a correlation between readmission and mortality, i.e. their rates were not both high or both low. Furthermore, among hospitals that were outliers in at least one of the measures, almost a third were in the category of low or normal readmission rates with higher than expected mortality.
The implications are twofold: first, readmission and mortality rates are not strongly correlated.
Second, focusing on readmission rates as an outcome will miss a large number of poorly performing hospitals with higher than expected mortality rates but low or expected readmissions.
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Medical Research.com Interview with:Gery P. Guy Jr., PhD, MPH, Health economist
CDC: Division of Cancer Prevention and Control’s Epidemiology and Applied Research Branch.
Medical Research:What is the background for this study? Dr. Guy: Skin cancer is the most commonly diagnosed cancer in the United States and is a growing public health problem. Melanoma, the deadliest form of skin cancer, is responsible for more than 12,000 deaths each year and is diagnosed in over 70,000 people per year. The number of skin cancer cases continues to increase every year, however little is known about the economic burden of treatment. The purpose of our study was to examine trends in the number of people treated for skin cancer and the cost of treatment.
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MedicalResearch.com Interview with:
Michele D. Levine Ph.D.
Associate Professor of Psychiatry and PsychologyWestern Psychiatric Institute and Clinic
Department of Statistics, University of Pittsburgh, Pittsburgh PA
Medical Research:What is the background for this study? What are the main findings?Dr. Levine: Many women quit smoking as a result of pregnancy. However, psychiatric disorders, which are prevalent among smokers can contribute to weight gain. Thus, we sought to examine the relationship between maternal psychiatric disorders and gestational weight gain in a sample of pregnant former smokers. Results from the present study demonstrate that the rates of psychiatric disorders were high among pregnant former smokers and that more than half of women gained more weight than recommended by the IOM. Although a history of having had any psychiatric disorder was not associated with gestational weight gain, a history of alcohol use disorder specifically was positively related to gestational weight gain.
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MedicalResearch.com Interview with: Vijay Ramanan, PhD
Indiana University Center for Neuroimaging (CfN)
Department of Radiology
Indianapolis, IN 46202
Medical Research: What is the background for this study? What are the main findings?Dr. Ramanan: Impairment in episodic memory is one of the first clinical deficits in early Alzheimer’s disease, the most common cause of dementia. Among other examples, this might be reflected as an inability to recall an article recently read or as difficulty remembering what one had for dinner last night. Unfortunately, the genetic and environmental mechanisms underlying these deficits are not fully understood. Our goal was to discover new genes and pathways underlying memory performance to help identify potential drug targets for protecting against and ultimately reversing memory loss in dementia and normal aging.
Through studying a large representative sample of older Americans, we discovered a variant (single nucleotide polymorphism or SNP) in the FASTKD2 gene associated with better memory performance and replicated this finding in independent samples. We then integrated additional data to extend our understanding of the effect of this SNP. For example, we know that the hippocampus is a vital brain structure for encoding and retrieving memories and it is well-understood that decreased hippocampal volume is a key early marker of Alzheimer’s disease and one that can be measured noninvasively through magnetic resonance imaging (MRI). We predicted that this new memory-protective SNP would be associated with increased hippocampal volume and this turned out to be true. We also discovered that carriers of this memory-protective SNP exhibited lower levels of proteins involved in cell death in the cerebrospinal fluid bathing the brain and spinal cord, a striking finding given that FASTKD2 encodes a protein that appears to promote apoptosis (i.e., programmed cell death). Together, these convergent findings are consistent with a neuroprotective effect of this novel SNP discovery. More broadly, our results nominate FASTKD2 and its functional pathways as potential targets for modulating neurodegeneration to combat memory loss in older adults.
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MedicalResearch.com Interview with:
Maryam Darvishian MSc
Department of Epidemiology, University Medical Center Groningen,
Unit of PharmacoEpidemiology and PharmacoEconomics (PE2),
Department of Pharmacy, University of Groningen, and Prof Edwin R van den Heuvel
Department of Epidemiology, University Medical Center Groningen,
University of Groningen, Groningen, NetherlandsDepartment of Mathematics and Computer Science,
Eindhoven University of Technology, Eindhoven, NetherlandsMedical Research: What is the background for this study? Reply: In most developed countries, seasonal influenza vaccine is the standard care for elderly people, but there exists still discussions on whether vaccination is effective. Conducting RCT is not considered ethical and thus the main body of evidence comes from observational studies. Unfortunately, these studies (e.g. cohort studies) are susceptible to different sources of biases especially selection bias which makes it difficult to judge the effectiveness. In recent years test-negative design (TND) studies has been designed. It is a special type of case-control study which would limit the bias, due to similar health care-seeking behavior in cases and controls. The current study is a meta-analysis of TND case-control studies. It is the first meta-analysis of this type of studies and also the first meta-analysis that combined 35 studies for estimation of influenza vaccine effectiveness. More specifically, the meta-analysis assesses the influenza vaccine effectiveness against laboratory-confirmed influenza (LCI) among the elderly population. (more…)
MedicalResearch.com Interview with:Wenjie Ma MS Doctoral Student
Harvard School of Public Health
Medical Research:What is the background for this study? What are the main findings?Response: De novo lipogenesis (DNL) is the process whereby excess carbohydrate and protein are converted into saturated fatty acids (SFAs) and monounsaturated fatty acids (MUFAs). Emerging animal and in vitro evidence suggests that DNL might play an important role in metabolic regulation and influence the pathogenesis of type 2 diabetes. We used circulating biomarkers SFAs and MUFAs to investigate the prospective associations with incident diabetes in the Cardiovascular Health Study, a community-based cohort of older US adults. We found that circulating palmitic acid and stearic acid were associated with higher risk of incident diabetes, whereas vaccenic acid was associated with lower risk. In contrast, dietary intakes of saturated fatty acids and monounsaturated fatty acids were not associated with diabetes risk.
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MedicalResearch.com Interview with:
Meera Viswanathan, PhD
RTI International, Research Triangle ParkNorth CarolinaMedical Research: What is the background for this study? What are the main findings?Dr. Viswanathan: Medications, when used appropriately, can alleviate symptoms. Often, however, they result in side effects, interact with one another, are prescribed incorrectly, or are taken incorrectly. These problems are particularly pronounced for the elderly who may have multiple chronic conditions and may be on numerous medications. We evaluated a variety of research studies and program evaluations regarding a distinct type of health care service known as Medication Therapy Management or “MTM.” The goals of MTM services are to help patients and their clinicians to optimize prescription and nonprescription drug regimens, thereby achieving better health outcomes from drug therapy, and. at the same time to minimize the potential for harms, such as incorrect dosing and duplicate medications. Some have proposed that optimizing drug regimens and preventing adverse drug events may reduce health-care-related costs.
Medication Therapy Management services are most often provided directly to patients by pharmacists. Sometimes the same pharmacists who dispense medications to patients offer Medication Therapy Management services as well; in other models, pharmacists working in a nondispensing role within a health care system, health insurance plan administering a prescription drug benefit program, or a centralized pharmacy call center may offer such services Although Medication Therapy Management can vary quite substantially in specifics, Medication Therapy Management programs in general share common elements; these include medication therapy review of all prescription drugs, over-the-counter products, and herbal or dietary supplements; patient education and counseling to solve issues with the drug regimen that a patient may be experiencing, such as side effects or difficulty remembering to take medications; and coordination and communication with the prescribing provider. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 allowed Medicare to expand access to Medication Therapy Management services for selected patients through Medicare Part D prescription drug benefits.
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MedicalResearch.com Interview with:Thomas M. Maddox MD MSc
Cardiology, VA Eastern Colorado Health Care System
Associate Director, VA CART Program
Associate Professor, Department of Medicine
University of Colorado School of Medicine
Medical Research: What is the background for this study? What are the main findings?Dr. Maddox: With the release of the updated cholesterol guidelines last year and their significant changes in recommendations, we wanted to see what the potential impact would be on U.S. cardiovascular practices. Specifically, we were interested in present cholesterol treatment and testing patterns, and how they would potentially need to change under the new guidelines.
We used the PINNACLE registry to conduct our investigation. Under the sponsorship of the American College of Cardiology, the registry collects EMR data from 111 cardiovascular practices around the U.S. We analyzed cholesterol treatment and testing patterns in approximately 1.2 million patients. We found that most patients qualified for cholesterol treatment with statins, but 32.4% weren't currently prescribed them. We also found that 22.6% of patients were being treated with non-statin lipid-lowering therapies which, under the new guidelines, aren't currently recommended for cholesterol treatment. Finally, we found that 20.8% of patients underwent repeated LDL-C testing, which may not be necessary under the new guidelines.
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MedicalResearch.com Interview with:
Dr. Wanjun Cui, MS PhD
Department of Health and Human Services,
Centers for Disease Control and Prevention (CDC)Medical Research:What is the background for this study? What are the main findings?
Authors’ response: Asthma is a leading chronic disease among adolescents that adversely affects their health. However, it is unclear how asthma influences their perceived health or health-related quality of life (HRQOL). Because their perceptions of their health may differ from those of their caregivers (such as parents or health professionals), knowing how adolescents with asthma would rate their own health is very important. Our study compares the responses of adolescents with and without asthma about different aspects of HRQOL including their overall health, their recent physical health, their recent mental health, and their recent activity limitations due to health. Unlike previous U.S. studies based on small clinical samples, our study used a nationally representative sample of U.S. adolescents that can be generalized to the whole U.S. adolescent population.
We found that asthma is adversely associated with almost all these aspects of HRQOL but only among those with asthma and current symptoms such as wheezing and dry cough. Adolescents with asthma without current symptoms did not report significantly worse HRQOL than those without asthma. For example, compared with those who never had asthma, adolescents with asthma and symptoms of dry cough or wheezing reported significantly more fair or poor self-rated health (14% vs. 8%), 34% more recent physically unhealthy days , and 26% more recent mentally unhealthy days. More importantly, adolescents with asthma who currently smoked cigarettes or reported limited physical functioning reported even worse physical and mental HRQOL.(more…)
MedicalResearch.com Interview with:
Dr. Kristy Lynn Kummerow MD
Division of Surgical Oncology and Endocrine Surgery
Vanderbilt University Medical Center
Tennessee Valley Healthcare System, Veterans Affairs Medical Center
Geriatric Research, Education, and Clinical Center
Nashville, Tenn
Medical Research: What is the background for this study? What are the main findings?Dr. Kummerow: This study looked at how we are currently treating early stage breast cancer in the US – early stage breast cancer includes small cancers with limited or no lymph node involvement and no spread to other body site – it was prompted by something we observed an our own cancer center, which is that more and more women seem to be undergoing more extensive operations than are necessary to treat their cancer. It is helpful to understand the historical context of how we treat early breast cancer. Prior to the 1980s, the standard of care for any breast cancer was a very extensive procedure, which involved removal of the entire breast, as well as underlying and overlying tissues and multiple levels of lymph nodes drained by that area. Informative clinical trials were completed in the 1980s demonstrated that these extensive procedures were unnecessary, and that equivalent survival could be achieved with a much more minimal operation, by removing only the tumor, with a margin of normal breast tissue around it, and performing radiation therapy to the area; this technique is now known as breast conservation surgery, also known as lumpectomy with radiation. In the 1990s, breast conservation was established by the national institutes of health and was embraced as a standard of care for early stage breast cancer; performance of breast conservation surgery also became a quality metric – accredited breast centers in the US are expected to perform breast conservation surgery in the majority of women who they treat for breast cancer. However, what our research team observed at our institution didn’t fit – over time it appears more aggressive surgical approaches are being used for more women. This has been found in other institutions as well, and is supported by smaller national studies. We wanted to understand how surgical management of early breast cancer is changing over time at a national level using the largest data set of cancer patients in the United States.
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MedicalResearch.com Interview with: Maria Pesonen MD, PhD
Specialist in Dermatology
Assistant Chief Medical Officer
Finnish Institute of Occupational Health
Occupational Medicine Helsinki, Finland
Medical Research: What is the background for this study? What are the main findings?Dr. Pesonen: Skin prick test is a widely used, established methods in assessing immediate (i.e. immunoglobulin E-mediated) sensitization. However, the knowledge on long-term reproducibility and predictive value of skin prick testing in children has been limited. We assessed the predictive value of skin prick testing in the setting of a follow-up study on healthy, unselected newborns, who were followed up to age 20 years with skin prick testing with 11 common allergens, structured interview and clinical examination at ages 5, 11 and 20 years. The reproducibility of skin prick test positivity at age 5 years was 100% at ages 11 and 20 years, i.e. none of the skin prick positive subjects turned negative during the follow-up. Gaining of new sensitizations to aeroallergens was common. Skin prick test positivity at age 5 years predicted allergic symptoms at ages 11 (sensitivity 28%, specificity 94%) and 20 years (sensitivity 23%, specificity 91%), but not atopic dermatitis.
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MedicalResearch.com Interview with: Kirsten Mehli
Department of Public Health and Community Medicine,
Sahlgrenska Academy, University of Gothenburg,
Gothenburg, Sweden
Medical Research:What is the background for this study?Dr. Mehlig: Many studies found that the ‘good’ HDL-cholesterol is associated with lower risk for atherosclerosis, and cardiovascular risk. This finding has not been translated into clinical practice because medical trials with HDL-cholesterol rising medication did rise the HDL-cholesterol but did not prevent CVD. One possible explanation could be that a high level of HDL-cholesterol is but a marker for other factors that truly contribute to reduced cardiovascular risk. One such factor is alcohol consumption, and ethanol intake in grams / day is associated with higher HDL-C in our study, too. Another factor is a certain genotype that has been found to modulate HDL-cholesterol levels. The fact that co-called ‘moderate’ alcohol consumption is beneficial wrt. CVD has been observed and discussed often, and is confirmed in our study. Here, we asked whether the beneficial effect of alcohol was further strengthened by having a favorable CETP genotype wrt. HDL-cholesterol.
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MedicalResearch.com Interview with:
Marie-Christine Aubry, M.D.
Professor of Laboratory Medicine and Pathology
Consultant, Department of Laboratory Medicine and Pathology,
Mayo Clinic in Rochester, Minn.
Medical Research: What is the background for this study? What are the main findings?Dr. Aubry: Up to 20% of patients will present with multifocal lung cancer or will develop a second lung cancer. The main clinical issue is distinguishing between independent primaries from true intrapulmonary metastases since this distinction will drive the therapy of the patient. Currently no ancillary studies allows for this distinction and the distinction is provider specific based on a combination of clinical, radiologic and pathologic assumptions. Based on our prior research using a method called mate pair sequencing , we observed that the probability of detecting identical chromosomal breakpoints in two unrelated tumors, from 2 different patients was basically zero. Similarly, when assessing different components within a single tumor, we always found identical chromosomal breakpoints between these components. We thus hypothesized that if two tumors within a patient were related, i.e. true metastasis, we should always find a number of identical chromosomal breakpoints between the tumors. And in contrast, if 2 tumors were truly independent primaries, we should not observe any chromosomal breakpoints in common.
We first studied a control group of patients that had
1- a primary lung cancer with a known distant metastasis (usually brain metastasis),
2- two lung cancers of different histologic subtype, adenocarcinoma and squamous cell carcinoma which are accepted as true independent primaries and
3- 1 tumor with different portions of the tumor being analyzed individually and compared as true relatedness.
There were thus a total of 11 pairs of tumors with predetermined status of independent primaries versus relatedness (ie metastasis or same tumor). The mate pair generated data showed a perfect concordance with this status. We then studied 11 pairs of lung tumors of similar histology (2 adenocarcinomas or 2 squamous cell carcinomas). The current gold standard for the distinction between independent primaries and intrapulmonary metastasis relies on a pathologist’s comparative morphologic assessment. In order to strengthen this gold standard, 2 pulmonary pathologists independently made this assessment. Interestingly, the pathologists agreed on the status of independent primaries and intrapulmonary metastasis in 9 (of 11) cases demonstrating the shortcomings of this gold standard. Furthermore, there were discordance between the pathologists’ prediction and the clinicians’ assessment in 3 of the 11 patients and the clinician could not come to a final assessment in 1 patient. The MP data was concordant with the pathology assessment in 8 of these 9 cases, and supported the pathologists’ prediction in 2 (of the 3) discordance with the clinical assumptions.
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MedicalResearch.com Interview with: Dr. Quanhe Yang PhD
CDC’s Division for Heart Disease and Stroke Prevention
What is the background for this study? What are the main findings?Dr. Yang: Our study reveals that an individual’s predicted risk of developing cardiovascular disease (CVD), coronary heart disease (CHD) and stroke over the next decade varies significantly from state-to-state, as well as by demographic factors including age, gender, race-ethnicity and household income.
Among the key findings: the 10-year risk is higher in the Southeast and lower in northwestern states – and higher among men than women. For men, the 10-year risk of developing CVD was 14.6 percent for the nation as a whole, ranging from a low of 13.2 percent in Utah to a high of 16.2 percent in Louisiana. CHD risk among men ranged from 9.5 percent in Utah to 11.7 percent in Louisiana, while stroke risk was 2.1 percent in Utah and 2.6 percent in Louisiana. Among women, CVD risk was 7.5 percent, ranging from 6.3 percent in Minnesota to as high as 8.7 percent in Mississippi. CHD risk for women ranged from 3.8 percent in Minnesota to 5.3 percent in Mississippi, while stroke risk was as low as 1.5 percent in Minnesota and as high as 2.1 percent in Mississippi. Nationally, we found the risk increased significantly with age and was highest among non-Hispanic blacks, those with less than a high school education and those with household incomes below $35,000 .
As part of this study, CDC researchers analyzed data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2010, as well as the 2009 Behavioral Risk Factor Surveillance System, the world’s largest ongoing telephone health surveillance system. The state-based, random-digit-dialed phone survey included information from almost 300,000 U.S. residents between the ages of 30 and 74.
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MedicalResearch.com Interview with:
Børge G Nordestgaard, MD, DMSc
Professor, University of Copenhagen
Chief Physician, Herlev Hospital, Copenhagen University Hospital
Dept. Clinical Biochemistry Herlev Ringvej Herlev, Denmark
Medical Research: What is the background for this study? What are the main findings?Prof. Nordestgaard: Many people take vitamin D supplements with the hope of reducing morbidity and mortality. However, it is unclear whether low vitamin D per se is a direct cause of increased mortality or whether it is simply a marker of poor lifestyle in general and/or underlying hidden disease. Our study involved 95,766 white participants of Danish descent from three cohorts in Copenhagen, who had genetic variants known to affect vitamin D levels. We found that genetically low vitamin D levels were associated with increased all-cause mortality, cancer mortality, and other mortality, but not with cardiovascular mortality. This is important as such genetics studies cannot be explained by poor lifestyle or hidden disease, as neither can change your genes.
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MedicalResearch.com Interview with:
Vasileia Varvarigou MD, Visiting Scientist at Harvard School of Public Health and Senior Medical Resident, St Elizabeth’s Medical Center, Tufts Medical School and
Stefanos N Kales MD, MPH, Associate Professor, Harvard School of Public Health, Division Chief of Occupational Medicine, Cambridge Health Alliance/ Harvard Medical School
Medical Research: What is the background for this study?
Response: Previous epidemiologic studies of firefighters have documented markedly increased risks of acute death from heart disease during strenuous activities such as fire suppression as compared to non-emergency duties. We hypothesized that certain law enforcement tasks could serve as an occupational trigger in susceptible police officers, leading to an increased frequency of sudden cardiac death during stressful duties.
Our main objective therefore, was to assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties.
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MedicalResearch.com Interview with:
Carl "Chip" Lavie MD, FACC
Medical Director, Cardiac Rehabilitation and Prevention
Director, Exercise Laboratories
John Ochsner Heart and Vascular Institute
Professor of Medicine
Ochsner Clinical School-UQ School of Medicine
Editor-in-Chief, Progress in Cardiovascular Diseases
Medical Research: What are the key points of your editorial?
Dr. Lavie:
1) The importance of higher fitness to predict a lower rate of developing Heart Failure;
2) improvements in fitness over time predict a lower rate of developing Heart Failure, and
3) Once Heart Failure develops, higher fitness predicts a more favorable prognosis.
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