Author Interviews, JAMA, MRI, Rheumatology / 07.02.2019

MedicalResearch.com Interview with: Signe Møller-Bisgaard MD, PhD Rigshospitalet Center for Rheumatology and Spine Diseases Copenhagen Center for Arthritis Research  MedicalResearch.com: What is the background for this study?  Response: The background was that to avoid long-term consequences of rheumatoid arthritis (RA) such as progressive joint damage progression leading to functional impairment and loss of quality of life, it is essential for patients with RA to achieve clinical remission, which is a disease state with no clinical signs and symptoms of disease activity. But despite treating our patients according to current clinical recommendations using targeted treatment strategies, so that the patients reach a state of remission, joint damage progression still occurs in one out of four patients. We knew, that MRI inflammatory findings such as synovitis and bone marrow edema are present in patients in clinical remission and are of prognostic value. In particular bone marrow edema has shown to be a strong predictor of erosive joint damage progression. In the IMAGINE-RA randomized clinical trial we therefore wanted to investigate if an MRI treat-to-target strategy targeting absence of bone marrow edema versus a conventional disease activity-guided treat-to-target strategy would improve clinical and radiographic outcome in rheumatoid arthritis patients in clinical remission.  (more…)
Anesthesiology, Author Interviews, JAMA, Surgical Research / 07.02.2019

MedicalResearch.com Interview with: Michael Avidan, MBBCh, FCA SA Dr. Seymour and Rose T. Brown Professor of Anesthesiology Chief of the Division of Clinical and Translational Research Director of the Infrastructure of Quality Improvement, Research and Informatics Washington University School of Medicine St Louis, MO  MedicalResearch.com: What is the background for this study? Response: Postoperative delirium, a temporary state of confusion and inattention, is common in older adults after major surgery. Delirium can be distressing to patients, family members and clinicians. It is associated with longer hospital stays, other medical complications, cognitive decline, and death. Some previous studies have found that using electroencephalography (EEG) monitoring of the brain during general anesthesia decreases the occurrence of delirium following surgery. Therefore we conducted a rigorous study to determine whether using information from the EEG to guide the safe reduction of inhaled anesthetic drugs would prevent postoperative delirium and improve other outcomes in older adults following major surgery. (more…)
Author Interviews, Diabetes, Diabetologia, Surgical Research / 07.02.2019

MedicalResearch.com Interview with: Lene Ring Madsen, MD, Ph.d. Medicinsk Afdeling  Herning Hospitalsenheden Vest Lene Ring Madsen, MD, Ph.d. Medicinsk Afdeling  Herning Hospitalsenheden Vest MedicalResearch.com: What is the background for this study? What are the main findings? Response: We know from previous studies that there is a significant chance of diabetes remission following Roux-en-Y gastric bypass, but most studies evaluate smaller cohorts of selected patients (e.g. from a single center or only patients covered by a specific type of insurance). By using Danish registries, which hold information on all Danish Citizens independent of social- or economic status and have complete follow-up, we wanted to evaluate the Roux-en-Y gastric bypass surgery (RYGB) in a real-world setting. The main findings are that more than 70 % of patients with obesity (BMI>35 kg/m2) and type 2 diabetes treated by RYGB had their diabetes go into remission or every 6-month period in the first 5 years after the procedure. Out of those who were in remission within the first year of follow-up 27% had undergone relapse at 5 years. The most important predictor of a patient not going into remission was if they required insulin to control their disease. Other factors included older age and higher starting HbA1c level. During the more than five years of follow-up, the risk of microvascular complications was 47% lower in the RYGB group than in the control population, with largest decreases in the risk of diabetic retinopathy and diabetic kidney disease. There was a smaller impact on the risk of macrovascular events, which were 24% lower among patients who had received bariatric surgery; however, this difference was not large enough to achieve statistical significance. The 90-day mortality was very low (<0.5%). (more…)
Author Interviews, Brain Injury, Exercise - Fitness, JAMA, Pediatrics / 07.02.2019

MedicalResearch.com Interview with: John J. Leddy, MD Clinical Professor Department of Orthopaedics Jacobs School of Medicine & Biomedical Sciences University of Buffalo MedicalResearch.com: What is the background for this study? Response: Sport-related concussion (SRC) is a significant public health problem without an effective treatment. Recent International Guidelines have questioned the efficacy of recommending complete rest to treat concussion and have called for prospective studies to evaluate early active treatments for sport-related concussion.  (more…)
Author Interviews, CDC, Flu - Influenza, OBGYNE, Pediatrics / 07.02.2019

MedicalResearch.com Interview with: Kim Newsome, MPH National Center on Birth Defects and Developmental Disabilities CDC  MedicalResearch.com: What is the background for this study? Response: This study supports data from previous studies that have shown increased risks for infants born to pregnant women who are severely ill with flu. MedicalResearch.com: What are the main findings? Response: Our study found that severely ill women with 2009 H1N1 influenza during pregnancy were more likely to have adverse birth outcomes (such as their baby being born preterm or of low birth weight) than women without influenza.  (more…)
Author Interviews, Heart Disease, OBGYNE / 07.02.2019

MedicalResearch.com Interview with: Professor Dino A. Giussani PhD ScD FRCOG Professor of Developmental Cardiovascular Physiology & Medicine Department of Physiology Development & Neuroscience University of Cambridge Director of Studies in Medicine College Lectureship in Medicine '1958' Gonville & Caius College UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: Heart disease kills 1 in 3 people worldwide.  When we hear about heart disease, the first thing we think of is a gene-environent interaction.  That is to say, how our genes interact with traditional lifestyle factors, such as smoking, obesity and/or a sedentary lifestyle to promote an increased risk of cardiovascular disease.  However,  it has also become established that the gene-environment interaction early in life may be just as, if not more, important in ‘programming’ future heart health and heart disease. That is to say, how the quality of the intrauterine environment in which we develop may also shape our future heart risk.  Evidence from human sibling-pair studies suggests that these relationships are causal, that they occur independently of genotype and that they are significantly influenced by the quality of the intrauterine environment during pregnancy.  For instance, bariatric surgery to decrease the weight of obese women reduced the risk of obesity, insulin resistance and raised blood pressure in children born after surgery compared to those born before. Therefore, these studies highlight a disproportionate risk of disease in offspring born from the same mother but under different in utero conditions, providing strong evidence in humans that the environment experienced during this critical period of development directly influences long-term cardiovascular health. One of the most common outcomes of complicated pregnancy in humans is chronic fetal hypoxia, as can occur during placental insufficiency or preeclampsia. The main findings of our study show that prenatal hypoxia can programme future heart disease in the offspring and that maternal treatment with the antioxidant vitamin C can be protective (see paper attached). (more…)
Author Interviews, Compliance, Electronic Records, Lung Cancer, Race/Ethnic Diversity / 07.02.2019

MedicalResearch.com Interview with: Samuel Cykert, MD Professor of Medicine and Director of the Program on Health and Clinical Informatics UNC School of Medicine, and Associate Director for Medical Education, NC AHEC Program Chapel Hill, NC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Reports going as far back as the early 1990’s through reports published very recently show that Black patients with early stage, curable lung cancer are not treated with aggressive, curative treatments as often as White patients. These type of results have been shown in other cancers also. It’s particularly important for lung cancer because over 90% of these patients are  dead within 4 years if left untreated. In 2010, our group published a study in the Journal of the American Medical Association that showed that Black patients who had poor perceptions of communication (with their provider), who did not understand their prognosis with vs. without treatment, and who did not have a regular source of care ( a primary care doctor) were much less likely to get curative surgery. Also our results suggested that physicians who treated lung cancer seemed less willing to take the risk of aggressive treatments in treating Black patients (who they did not identify with as well) who had other significant illnesses. Because of the persisting disparities and our 2010 findings, we worked with a community group, the Greensboro Health Disparities Collaborative to consider potential solutions.  As these omissions were not overt or intentional because of race on the part of the patients or doctors, we came up with the idea that we needed transparency to shine light on treatment that wasn’t progressing and better communication to ensure that patients were deciding on good information and not acting on mistrust or false beliefs.  We also felt the need for accountability – the care teams needed to know how things were going with patients and they needed to know this according to race. To meet these specifications, we designed a system that received data from electronic health records about patients’ scheduled appointments and procedures. If a patient missed an appointment this umbrella system triggered a warning. When a warning was triggered, a nurse navigator trained specially on communication issues, re-engaged the patient to bring him/her back into care. In the system, we also programmed the timing of expected milestones in care, and if these treatment milestones were not reached in the designated time frame, a physician leader would re-engage the clinical team to consider the care options. Using this system that combined transparency through technology, essentially our real time warning registry, and humans who were accountable for the triggered warnings, care improved for both Black and White patients and the treatment disparity for Black patients was dramatically reduced. In terms of the numbers, at baseline, before the intervention, 79% of White patients completed treatment compared to 69% of Black patients. For the group who received the intervention, the rate of completed treatment for White patients was 95% and for Black patients 96.5%.  (more…)
Author Interviews, Opiods, Social Issues / 06.02.2019

MedicalResearch.com Interview with: Lawrence M. Kessler, PhD Research Assistant Professor Matthew C. Harris, PhD Assistant Professor Boyd Center for Business and Economic Research and Department of Economics The University of Tennessee     MedicalResearch.com: What is the background for this study? Response: Motivation for this study came from Co-Author, Matt Murray, who was at a speaking engagement and heard a community business leader say “we’ve got jobs, but no one is applying, could opioids be a contributing factor?” This led to a conversation back at the Boyd Center between us and Matt Murray, where we decided that if we could get data on prescription rates, we could answer this question empirically. We started by contacting each state agency in charge of their respective prescription drug monitoring program to see if they’d be willing to share county-level data on prescription opioid rates. From this letter-writing campaign we received data from 10 states, which formed the basis for our analysis. As time went on, new data was made publicly available and we were able to expand the analysis to all 50 states. (more…)
Author Interviews, Mammograms / 06.02.2019

MedicalResearch.com Interview with: "Kiki Gets a Mammogram" by kristiewells is licensed under CC BY-NC-SA 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by-nc-sa/2.0Philippe Henrot, MD Radiology Department Institut de Cancerologie de Lorraine Vandoeuvre-les-Nancy  MedicalResearch.com: What is the background for this study? What are the main findings? Response: The initial observation was that daily practice of mammography shows a substantial proportion of women that report a negative experience after having a mammogram. Compression of the breast before delivering X-rays is mandatory to achieve the best image quality and to detect small cancers. Unfortunately, compression is uncomfortable, even sometimes painful. We took into consideration a study of PJ Kornguth et al. published in 1993 reporting the self-compression technique. In this study one breast was compressed by the radiographer and the other with self-compression. The author reported a high level of patient satisfaction, and a lower discomfort, without compromising image quality. We performed a multicenter prospective randomized trial to demonstrate the feasibility of the self-compression technique in condition similar to routine screening or follow-up, compared with standard compression. The primary outcome was to demonstrate that self-compression did not lead to compress the breast less than standard compression, and that was done. The secondary outcomes were to evaluate pain, compression force and image quality. The results indicated that compression force was higher when the women controlled themselves the compression of their breast, and the pain measured on a visual analogue scale was lower. Moreover, image quality was not compromised compared with standard compression.  (more…)
Accidents & Violence, Author Interviews, Dermatology / 06.02.2019

MedicalResearch.com Interview with: Dr Sarah Hall PhD Senior Lecturer in Forensic Science Anglia Ruskin University MedicalResearch.com: What is the background for this study? Response: We initially started the study in collaboration with Essex Fire and Rescue Services, as we were already doing some research on the recovery of evidence from fire scenes. During a visit to their cold fire scene facility, they described a tragic fatality with extensive fire damage, which didn’t link with the main fuel in the room. Therefore they questioned if a skin cream, regularly used by the victim, could have contributed as a fuel or ignited to initiate the fire and asked if we would do some initial research. Now we are also working with West Yorkshire and Cambridgeshire Fire and Rescue Service, the London Fire Brigade, St Andrews Centre for Plastic Surgery and Burns and the National Fire Chiefs Council. We initially started the study in collaboration with Essex Fire and Rescue Services, as we were already doing some research on the recovery of evidence from fire scenes. During a visit to their cold fire scene facility, they described a tragic fatality with extensive fire damage, which didn’t link with the main fuel in the room. Therefore they questioned if a skin cream, regularly used by the victim, could have contributed as a fuel or ignited to initiate the fire and asked if we would do some initial research. Now we are also working with West Yorkshire and Cambridgeshire Fire and Rescue Service, the London Fire Brigade, St Andrews Centre for Plastic Surgery and Burns and the National Fire Chiefs Council. (more…)
Author Interviews, Diabetes, Education, JAMA, Pediatrics / 06.02.2019

MedicalResearch.com Interview with: Niels Skipper PhD Associate Professor, Department of Economics and Business Economics Aarhus University MedicalResearch.com: What is the background for this study? What are the main findings? Response: It is unclear if there is an association between type 1 diabetes and school performance in children. Some studies have found type 1 diabetes to be associated with worse performance, while others have found no differences. However, most of the existing literature are based on smaller, non-random samples of children with diabetes. In this study we used data on all public school children in the country of Denmark, involving more than 600,000 schoolchildren where approximately 2,000 had a confirmed diagnosis of type 1 diabetes. The children were tested in math and reading using a nationally standardized testing procedure, and we found no difference in the obtain test scores between children with diabetes compared to children without diabetes.  (more…)
Author Interviews, Cost of Health Care, Critical Care - Intensive Care - ICUs, Health Care Systems, Hospital Acquired, JAMA, Urinary Tract Infections / 06.02.2019

MedicalResearch.com Interview with: Heather Hsu, MD MPH Assistant Professor of Pediatrics Boston University School of Medicine Boston Medical Center Boston, MA 02118 MedicalResearch.com: What is the background for this study? What are the main findings?  Response: In October 2013, the Centers for Medicare and Medicaid Services (CMS) implemented value-based incentive programs to financially reward or penalize hospitals based on quality metrics. Two of these programs – Hospital Value Based Purchasing and the Hospital Acquired Condition Reduction Program – began targeting hospitals’ rates of certain healthcare-associated infections deemed to be preventable in October 2015. Previous studies demonstrated minimal impact of these value-based payment programs on other measures of hospital processes, patient experience, and mortality. However, their impact on healthcare-associated infections was unknown. Our goal was to study the association of value-based incentive program implementation with healthcare-associated infection rates, using catheter-associated urinary tract infection in intensive care units (one of the targeted outcomes) as an example. We found no evidence that federal value-based incentive programs had any measurable association with changes in catheter-associated urinary tract infection rates in the critical care units of US hospitals. (more…)
Author Interviews, Dermatology, MRI, NEJM / 06.02.2019

MedicalResearch.com Interview with:

Dr. Martina Callaghan PhD Head of Physics & Senior Lecturer Wellcome Centre for Human Neuroimaging Institute of Neurology University College London London

MedicalResearch.com:  What is the background for this study?  What are the main findings?

Response: As mirrors the situation in the general population, we found that an increasing number of volunteers who were seeking to enter cognitive neuroscience studies at our Centre had tattoos. However, the magnetic fields used in magnetic resonance imaging (MRI) pose a potential safety risk for people with tattoos. A number of case reports have described such incidents.  However, as these describe isolated cases retrospectively, there was not enough information to objectively assess the risk of tattoo-related adverse reactions for persons having an MRI scan.  Therefore, in 2011, we decided to embark upon this first prospective study to quantitatively assess this risk.

(more…)
Author Interviews, Beth Israel Deaconess, Brigham & Women's - Harvard, Frailty, Heart Disease, Surgical Research / 05.02.2019

MedicalResearch.com Interview with: Dae Hyun Kim, MD, MPH, ScD Assistant Professor of Medicine, Harvard Medical School Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center MedicalResearch.com: What is the background for this study? What are the main findings? Response: The number of older adults undergoing aortic valve replacement is increasing.  Since these patients are at high risk for complications and functional decline due to preexisting multimorbidity and frailty, the latest guideline (Otto et al. J Am Coll Cardiol 2017;69:1313–46) emphasizes shared decision-making based on patient-centered outcomes.  Despite this recommendation, we witness many decision-making processes are cardio-centric—mainly informed by expected benefit in terms of cardiac-specific measures.  Many patients are not adequately informed about what their daily life would be like after the procedure. In this single-center prospective cohort study, we examined functional status trajectories via assessments of global functional status at 1, 3, 6, 9, and 12 months in 246 patients who underwent transcatheter and surgical aortic valve replacement.  We identified 5 clinically meaningful functional trajectories, ranging from high baseline function-early complete recovery to low baseline function-large and persistent decline.  We were able to predict most likely trajectory as well as best possible and worse possible trajectories using the preoperative frailty index.  Delirium and postoperative complications were also strongly associated with undesirable functional trajectories.  (more…)
Author Interviews, JAMA, Ophthalmology, Pediatrics, STD, USPSTF / 05.02.2019

MedicalResearch.com Interview with: Michael Silverstein, M.D., M.P.H. Professor of Pediatrics Director of the Division of General Academic Pediatrics Vice chair of research for the Department of Pediatrics Boston University School of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Gonococcal ophthalmia neonatorum, or GON, is a severe infection of the eye that can occur in babies born to women who have gonorrhea. If left untreated, GON can cause serious problems, including blindness, that can appear as soon as 24 hours after delivery. Fortunately, there are effective treatments available that can prevent GON in newborns. The U.S. Preventive Services Task Force reviewed the most current research on the benefits and harms of ocular prophylaxis—which is applying antibiotic ointment to the babies’ eyes at birth—to prevent GON. We found that, if applied within 24 hours after birth, the ointment is very effective at preventing gonococcal ophthalmia neonatorum and the problems it causes. Therefore, we are recommending that clinicians provide this preventive service for all newborns.  (more…)
Author Interviews, JAMA, Thyroid, Thyroid Disease / 04.02.2019

MedicalResearch.com Interview with: Joanna Klubo-Gwiezdzinska, M.D., Ph.D., M.H.Sc. Assistant Clinical Investigator/Assistant Professor Metabolic Disease Branch/NIDDK/NIH Bethesda, MD MedicalResearch.com: What is the background for this study? What are the main findings? Response: People with intermediate- and high-risk differentiated thyroid cancer (DTC) are treated with surgical removal of the thyroid gland and radioactive iodine therapy.  After surgery and initial treatment, the thyroid hormone levothyroxine is used for long-term management not only to replace appropriate physiologic thyroid hormones post-surgery, but also to suppress thyrotropin (TSH) release from the pituitary gland at supraphysiologic doses. The current recommended American Thyroid Association TSH suppression goal in patients with a high-risk differentiated thyroid cancer presenting with distant metastases is less than 0.1mIU/ml, and between 0.1-0.5 mIU/ml for patients with intermediate-risk DTC presenting with local metastases to the neck lymph nodes. This TSH goal is much lower than physiologic TSH level, which ranges between 0.4-4.1 mIU/ml, depending on the measurement method and person’s age. TSH suppression is used because some preclinical evidence suggests that TSH can stimulate growth of cancer cells.  However, several preclinical studies show that thyroid hormones may also stimulate cancer growth. In addition, too much levothyroxine, leading to TSH suppression, may cause side effects such as abnormal heart rhythms and decreased bone mass. In this study, based on a large multicenter database analysis, we found that continuous TSH suppression with levothyroxine was not associated with better progression-free survival and overall survival in patients with either intermediate- and high-risk differentiated thyroid cancer. The patients were followed for an average of 7 years after surgical thyroid cancer removal and radioactive iodine therapy.  (more…)
Author Interviews, Pain Research, Stroke / 04.02.2019

MedicalResearch.com Interview with Michelle Androulakis, MD, MS, FAHS Chief of Neurology WJB Dorn VA Medical Center and Faculty at University of South Carolina. Columbia, SC MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Even though Migraine with aura was associated with an increased risk of ischemic stroke in the Atherosclerosis Risk in Communities study (ARIC), our post-hoc showed unexpected results that onset of such migraines before age 50 years is not associated with such risk. Instead, later onset of migraine with aura after age of 50 was linked with a higher risk of ischemic stroke. Total of 447 migraineurs with aura (MA) and 1128 migraineurs without aura (MO) among 11,592 participants were included in the analysis. There was a two-fold increased risk of ischemic stroke when the age of migraineurs with aura onset was 50 years or older as compared with no headache participants, MO was not associated with increased stroke risk regardless of age of onset.  (more…)
Aging, Author Interviews, Exercise - Fitness, Frailty / 04.02.2019

MedicalResearch.com Interview with: "DSC08418" by Debs (\xf2\u203f\xf3)\u266a is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Cathie Sherrington FAHMS Professor, NHMRC Senior Research Fellow Institute for Musculoskeletal Health The University of Sydney MedicalResearch.com: What is the background for this study? What types of exercise were tested or indicated? Response: Falls are a very common problem with at least one in three people aged 60+ falling each year. This review included all types of exercises delivered to people aged 60+ in the general community i.e., not those living in supported accommodation and not among people with particular health conditions such as a stroke or Parkinson’s disease. (more…)
Author Interviews, General Medicine, Heart Disease, Science, Weight Research / 04.02.2019

MedicalResearch.com Interview with: Vitor Engrácia Valenti, PhD Professor São Paulo State University Marília MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Autonomic modulation and cardiorespiratory variables are influenced by numerous factors. Abdominal fat tissue is a relevant variables related to metabolic and cardiovascular disorders, including diabetes mellitus, dyslipidemia and hypertension, which are associated to increased risk of morbidity and mortality. We evaluated cardiorespiratory variables and autonomic nervous system before and during recovery from exercise in healthy physically active men divided according to with waist-stature ratio (WSR): G1 – between 0.40 and 0.449 (N = 19), and G2 – between 0.45 and 0.49. This metholodigcal procedure is able to provide important information regarding the risk for developing cardiovascular disease in the future. Our main findings indicated that healthy physically active men with waist-stature ratio values close to the risk limit (between 0.449 and 0.5) presented slower return of autonomic and cardiorespiratory variables to baseline values after moderate exercise. It suggests that this group present an elevated probability of developing cardiovascular disease in the future compared to the groups with lower values of waist-stature ratio. (more…)
Antibiotic Resistance, Asthma, Author Interviews, JAMA / 04.02.2019

MedicalResearch.com Interview with: Mihaela S Stefan, MD, PhD FACP Research Scientist, Institute for Healthcare Delivery and Population Science Associate Professor, UMMS-Baystate Director of Perioperative Clinic and Medical Consultation Program Academic Hospitalist Director Quality Assessment, Division of Healthcare Quality Springfield MA MedicalResearch.com: What is the background for this study? What are the main findings? Response: In a prior study we have found that roughly 41% of patients hospitalized with an asthma exacerbation receive antibiotics although the guidelines do not support this practice. We found that the evidence supporting the guidelines was however limited to 6 trials which included a total of only 681 adults and children and most trials’ outcomes were symptoms or lung function not length of stay, need for mechanical ventilation, readmissions or death. We performed the largest observational study to-date of approximately 20 000 patients hospitalized for asthma exacerbation and found that patients treated with antibiotics did not have better outcomes but instead they had longer hospital stay and an increased risk for antibiotic-related diarrhea. (more…)
Author Interviews, Cancer Research, Global Health, Lancet, Weight Research / 04.02.2019

MedicalResearch.com Interview with: Hyuna Sung, PHD Principal Scientist, Surveillance Research American Cancer Society, Inc. 250 Williams St. Atlanta, GA 30303  MedicalResearch.com: What is the background for this study? Response: This project was motivated by our previous finding on the rise of colorectal cancer among young adults before age 55. Changes in cancer trends among young age group have significant implications because the newly introduced carcinogenic agents are likely to affect trends among young people before they affect those among older people. Owing to this relationship, cancer trends among young people can be often considered as a bellwether for future disease burden. Given the dramatic increase of the obesity prevalence during 3-4 decades in the US, we wanted to expand the colorectal cancer finding to the more comprehensive list of cancers and explain them in the context of obesity epidemic. (more…)
Author Interviews, CMAJ, Fertility, McGill, OBGYNE / 04.02.2019

MedicalResearch.com Interview with: Natalie Dayan MD MSc FRCPC General Internal Medicine and Obstetric Medicine, Clinician-Scientist, Research Institute Centre for Outcomes Research and Evaluation (CORE) McGill University Health Centre Montréal QC MedicalResearch.com: What is the background for this study? What are the main findings? Response: Infertility treatment is rising in use and has been linked with maternal and perinatal complications in pregnancy, but the extent to which it is associated with severe maternal morbidity (SMM), a composite outcome of public health importance, has been less well studied. In addition, whether the effect is due to treatment or to maternal factors is unclear. We conducted a propensity matched cohort study in Ontario between 2006 and 2012. We included 11 546 women who had an infertility-treated pregnancy and a singleton live or stillborn delivery beyond 20 weeks. Each woman exposed to infertility treatment was then matched using a propensity score to approximately 5 untreated pregnancies (n=47 553) in order to address confounding by indication. Poisson regression revealed on overall 40% increase in the risk of a composite of SMM (one of 44 previously validated indicators using ICD-10CA codes and CCI procedure codes) (30.3 per 1000 births vs. 22.8 per 1000 births, adjusted relative risk 1.39, 95% CI 1.23-1.56). When stratified according to invasive (eg., IVF) and non-invasive treatments (eg. IUI or pharmacological ovulation induction), women who were treated with IVF had an elevated risk of having any severe maternal morbidity, and of having 3 or more SMM indicators (adjusted odds ratio 2.28, 95% CI 1.56 – 3.33), when compared with untreated women, whereas women who were treated with non-invasive treatments had no increase in these risks. (more…)
Author Interviews, Eating Disorders, OBGYNE / 04.02.2019

MedicalResearch.com Interview with: Valentina Tonei, PhD British Academy Research Associate Department of Economics and Related Studies University of York, UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: There has been a growing utilisation of Caesarean sections in the past decades. To put it in a perspective, in the United Kingdom, the caesarean section rate was about 26% in 2015, while in 1990s it was about 12-15%. A similar increase has been observed in other countries, for example in the USA. So, while this study focuses on the United Kingdom, I believe that the evidence from this research can apply also to other countries. I study the health consequences for mothers who give birth through an emergency caesarean. Thanks to previous studies, we are well-aware of the implications for mothers’ physical health; instead, this research sheds light on the impact on new mothers’ mental health. I find that new mothers who have an emergency caesarean delivery are at higher risk of developing postnatal depression in the first 9 months after the delivery.  (more…)
Author Interviews, Education, JAMA, Pediatrics / 03.02.2019

MedicalResearch.com Interview with: Sheri Madigan, Ph.D, R.Psych Canada Research Chair in Determinants of Child Development Assistant Professor, Department of Psychology Alberta Children's Hospital Research Institute University of Calgary MedicalResearch.com: What is the background for this study? What are the main findings? Response: Parents are reporting that screen time is one of their major concerns, so we wanted to find out more about how large of a role screen time was playing on children’s developmental outcomes. We were especially interested in the long-term impact of screens, which is why we followed children over time, from ages 2 to 5 and repeatedly assessed both screen time use and children’s achievement of developmental milestones. There are three main findings:
  1. Our study revealed that on average children were viewing screens for 2.4, 3.6 and 1.6 hours per day at two, three and five years of age, respectively. This means that the majority of the participants in our sample are exceeding the American Academy of Pediatrics’ guideline.
  2. We found statistically significant, albeit small effects suggesting that greater amounts of screen time at two and three years predict poorer child outcomes at three and five years, respectively. Thus, screen time has a lasting influence on children’s development.
  3. The opposite pattern was not observed. That is, we did not find evidence that children showing poor performance in terms of achieving developmental milestones were more likely to be place in front of screens to help cope with their potentially challenging behaviors.
(more…)
Author Interviews, JAMA, Opiods / 02.02.2019

MedicalResearch.com Interview with: "Opioids" by KSRE Photo is licensed under CC BY 2.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by/2.0Dr. Qiushi Chen (first author) and Jagpreet Chhatwal PhD Assistant Professor, Harvard Medical School Senior Scientist, Institute for Technology Assessment Massachusetts General Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: Opioid overdose epidemic is a national public health emergency — in 2017, more than 49,000 people died from overdose. Our study shows that under current conditions, the number of deaths is projected to increase to 81,700 by 2025. Efforts to curb the epidemic by reducing the incidence of prescription opioid misuse — the primary focus of current interventions — will have a modest effect of 3-5% reduction in overdose deaths. (more…)
Author Interviews, Orthopedics, Technology / 02.02.2019

MedicalResearch.com Interview with: Professor Sherry Towfighian PhD Mechanical Engineering Binghamton University   MedicalResearch.com: What is the background for this study? What are the main findings?  Response: We wanted to avoid using batteries in a load monitor that can be placed in total knee replacement. We looked into energy scavenging technologies and studied the most appropriate one for this application. Energy scavenging is converting wasted energy such as walking to electricity for low power sensors. Our research study showed walking can provide enough electrical energy (about 6 microwatts) for low power load sensors. These load sensors are important in providing information about the mechanical load throughout different activities. It can be used in the future to create a self -awareness device for the patient to avoid certain activities.  (more…)
Author Interviews, Dermatology, Infections / 01.02.2019

MedicalResearch.com Interview with: Wenquan Zou, MD, PhD Associate Professor Departments of Pathology and Neurology Director of CJD Skin Project Associate Director National Prion Disease Pathology Surveillance Center Institute of Pathology Case Western Reserve University School of Medicine Cleveland, Ohio 44106 MedicalResearch.com: What is the background for this study? Would you briefly explain the significance of prion-induced diseases and why they have been difficult to diagnosis? Response: Our previous study has demonstrated that infectious prions are detectable in the skin samples of patients with sporadic Creutzfeldt-Jakob disease (sCJD), the most common form of human prion disease, at the terminal stage by the highly sensitive real-time quaking-induced conversion (RT-QuIC) assay and animal-based bioassay. The prion-induced diseases are significant because they are infectious diseases that can be transmitted inter-species and intra-species. For instance, mad cow disease, a prion disease in cattle, has been documented to transmit to humans. Currently, there are no cures for these fatal diseases. The definite diagnosis of prion diseases is difficult because it mainly depends on the availability of brain tissues obtained either by biopsy or autopsy for detection of prions. Brain biopsy is highly invasive and it is difficult to be accepted by patients and their families. Even for brain autopsy, it is not always feasible because of religious and cultural limitations in some regions or countries.  (more…)
Author Interviews, Diabetes, JAMA, Primary Care / 01.02.2019

MedicalResearch.com Interview with: Diane M. Gibson, Ph.D. Executive Director – New York Federal Statistical Research Data Center, Baruch RDC Associate Professor – Marxe School of Public and International Affairs, Baruch College - CUNY MedicalResearch.com: What is the background for this study? What are the main findings? Response: Prior studies have found that screening for diabetic retinopathy in primary care settings using telemedicine increased screening rates among individuals with diabetes and among subgroups of individuals with diabetes who are at high risk of missing recommended eye exams.  In a previous paper I looked at how often U.S. adults with diabetes visited primary care and eye care providers for recommended diabetes preventive care services using a sample from the 2007-2013 Medical Expenditure Panel Survey.  I found that while visits to eye care providers were often skipped, most adults with diabetes did visit primary care physicians.  I argued that these findings suggest that screening for diabetic retinopathy in primary care settings using telemedicine has the potential to fulfill unmet needs and reach most U.S. adults with diabetes. My brief report in JAMA Ophthalmology examines patterns of eye examination receipt and visits to primary care physicians among U.S. adults with diabetes using a sample from the 2016 National Health Interview Survey.  The report pays particular attention to individuals who are at high-risk of missing recommended eye exams. The study found that 87.7% of the sample of adults with diabetes visited a primary care physician in the past year and that, except for the uninsured subgroup, more than 78% of each high-risk subgroup visited a primary care provider in the past year.  (more…)
ADHD, Author Interviews, Genetic Research, Mental Health Research, Pediatrics, Schizophrenia / 31.01.2019

MedicalResearch.com Interview with: Silvia Alemany, PhD first author Barcelona Institute for Global Health (ISGlobal), a centre supported by "la Caixa". In collaboration with co-authors: Philip Jansen,MD, MSc and Tonya White, MD, PhD Erasmus University Medical Center, Rotterdam MedicalResearch.com: What is the background for this study? Response: Individuals affected by psychiatric disorders can demonstrate morphological brain abnormalities when compared to healthy controls. Although both genetic and environmental factors can account for these brain abnormalities, we expect that genetic susceptibility for psychiatric disorders has the greatest influence on the development of the brain. Genetic susceptibility for psychiatric disorders can be estimated at the individual level by generating polygenic risk scores. Using this methodology, genetic susceptibility to psychiatric disorders and cognition has been associated with behavior problems in childhood. These findings suggest that heritable neurobiological mechanisms are at play in very early in the course of the illnesses. (more…)